PURPOSE: Laparoscopic instruments have been remarkably developed through many trials. Various studies and experiments on laparoscopic instruments are underway in other countries. Laparoscopic surgery is also very actively applied in Korea. However, research on the use and safety of the instruments is stagnant. Furthermore, reuse of some disposable laparoscopic instruments is frequently observed, but there are only rare studies on the safety of this. Thus, we tried to provide study cases on the safety of repeated use of disposable laparoscopic instruments. METHODS: To investigate the effectiveness of sterilization and a re-package procedure, we divided the laparoscopic instruments that are commonly used in our institution into 10 types. Among all the available instruments, 32 instruments were selected for the simulation experiment. Each instrument was sterilized using ethylene oxide gas or glutaraldehyde 2%, and then packaged. Then, each was observed grossly and microscopically under aseptic conditions and we looked for any remnant foreign body or contaminant. When remnant foreign body or contaminant was found, they were collected and separately cultured. RESULTS: Residual contaminants were found in 15 instruments (46.9%) out of a total of 32 and microorganisms, including coagulase-negative staphylococcus and gamma-hemolytic streptococcus, were cultured from (9.38%), and each had different types of microorganisms. CONCLUSION: It is remarkable that the bacteria were cultured from recycled laparoscopic instruments after sterilization. The reuse of laparoscopic instruments might be cost-effective, but further studies on its safety are required. Moreover, careful inspection on the method of surgical instrument sterilization in each institution will be necessary.
Bacteria ; Ethylene Oxide ; Ethylenes ; Foreign Bodies ; Glutaral ; Korea ; Laparoscopy ; Staphylococcus ; Sterilization ; Streptococcus ; Surgical Instruments

BACKGROUND: Many infections are associated with antiphospholipid antibodies (aPLs). The purpose of this study was to investigate the prevalence, persistence, clinical significance, and characteristics of aPLs in hepatitis B virus (HBV)-infected patients. METHODS: This study included 143 patients with HBV infection and 32 healthy individuals as controls. The presence of anticardiolipin antibodies (aCL Ab), anti-beta2-glycoprotein I antibodies (beta2GPI Ab), and lupus anticoagulant (LA) was assessed. RESULTS: The total prevalence of aPLs in HBV-infected patients was 12.6% (18 of 143). Of these 18 patients, 15 had low to medium titers of aCL Ab (10 with IgM, 4 with IgG, and 1 with both isotypes). beta2GPI Ab and LA were detected in 3 (2.1%) and 2 (1.4%) patients with HBV infection, respectively. In follow-up specimens from 14 patients with elevated levels of aCL Ab or beta2GPI Ab, 10 (71.4%) showed the persistent presence of aPLs. No clinical manifestations related to aPLs were identified. CONCLUSION: In HBV-infected patients, the most frequently detected antiphospholipid antibodies were IgM aCL Ab, which have a weak association with the clinical manifestations of APS. Unlike the transient presence reported for other infection-associated aPLs, most aPLs were persistently detected over a 12-week period in patients with HBV infection.
Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Follow-Up Studies ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Lupus Coagulation Inhibitor ; Prevalence

Objective: Peritonitis is a life-threatening, emergent surgical disease with very high mortality and morbidity. Currently, there are insufficient Korean studies using the P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and the Mannheim Peritonitis Index (MPI) as risk prediction models for nontraumatic peritonitis patients who visit the emergency room. Methods: This retrospective study was carried out on 196 cases of non-traumatic peritonitis in a single emergency center from January 2015 to December 2019. Receiver operating characteristic (ROC) curves were obtained and the area under the ROC curve (AUC) was compared using both P-POSSUM and MPI. The observed mortality and expected mortality for P-POSSUM were compared using the goodness of fit assessed using the Hosmer-Lemeshow equation. Results: Diastolic blood pressure, blood urea nitrogen, potassium, length of stay, and intensive care unit admissions were significantly different between survivors and non-survivors. The AUC was 0.812 for P-POSSUM and 0.646 for MPI. The observed-to-expected mortality ratio for P-POSSUM indicated fewer than expected deaths in all quintiles of risk and this was more pronounced, especially when the expected mortality was over 60%. Conclusion In non-traumatic peritonitis patients, P-POSSUM was more useful in predicting risk than the MPI score. However, P-POSSUM overestimated the risk in high-risk patients. Although the MPI score is only somewhat useful for predicting mortality in patients with non-traumatic peritonitis, it is useful as an adjuvant.

The presence of serum antibodies to various gangliosides, such as anti-GQ1b, is closely related to the clinical features of Guillain-Barre syndrome. However, the phenotype associated with anti-GT1a IgG has not yet been determined, although it has been detected in some cases of the pharyngeal-cervical-brachial variant. We report herein two patients harboring anti-GT1a IgG who both presented with profound dyspnea, dysphagia, and quadriparesis. The findings of this report suggest that the anti-GT1a antibody specifies a clinical feature of oropharyngeal palsy.
Antibodies ; Deglutition Disorders ; Dyspnea ; Gangliosides ; Guillain-Barre Syndrome ; Humans ; Immunoglobulin G ; Paralysis ; Phenotype ; Quadriplegia

BACKGROUND: Aldosterone induces renal injury independent of angiotensin II. This harmful effect might be mediated via inflammatory reaction. Aldosterone receptor blockade can retard renal damage in various renal diseases including diabetic nephropathy. However, it is not clear which mechanism is related to the beneficial effect of aldosterone receptor blockade in diabetic nephropathy. Therefore, we investigated whether aldosterone receptor blockade, spironolactone, inhibited inflammatory changes in Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a model of type 2 diabetes. METHODS: To determine the inflammatory effects, urinary MCP-1 protein was measured by ELISA, and intrarenal MCP-1 mRNA and ED-1 expression were examined by RT-PCR and immunohistochemistry, respectively. RESULTS: Blood glucose concentration were higher in diabetic rats than in control rats. Urinary protein excretion was significantly higher in diabetic rats compared with controls since twenty weeks, and proteinuria of the diabetic rats was decreased by spironolactone treatment. Urinary excretion of monocyte chemoattractant peptide-1 (MCP-1) was rapidly increased at the early period in diabetic rats. Spironolactone suppressed urinary level of MCP-1 compared to untreated diabetic rats. Immunohistochemistry revealed a significant increase in ED-1 staining in the diabetic kidney, and spironolactone treatment significantly suppressed intrarenal ED-1 expression in diabetic rats. CONCLUSION: Aldosterone receptor blockade, spironolactone, suppressed proteinuria and inflammatory changes in diabetic rats. These results suggest that spironolactone may have an anti-inflammatory effect in diabetic nephropathy.
Aldosterone* ; Angiotensin II ; Animals ; Blood Glucose ; Diabetic Nephropathies* ; Enzyme-Linked Immunosorbent Assay ; Immunohistochemistry ; Inflammation ; Kidney ; Monocytes ; Proteinuria ; Rats ; Receptors, Mineralocorticoid* ; RNA, Messenger ; Spironolactone

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.
Contracts ; Humans ; Myocardial Contraction ; Prospective Studies ; Relaxation ; Ventricular Function

Since Sampson first described the development of ovarian carcinoma in endometriosis in 1925, numerous case reports have documented the development of malignancies arising from foci of endometriosis. Clear cell carcinoma arising from endometriosis is very rare in the vulva. To date only two cases that originated in the vulva have been reported. We report a case of clear cell carcinoma in the vulva arising from endometriosis with a brief review of literatures.
Endometriosis* ; Female ; Vulva*

PURPOSE: To evaluate the CT and MRI findings of the large endolymphatic duct or sac syndrome (LEDS) and its associated anomalies, with clinical features. MATERIALS AND METHODS: We retrospectively reviewed the MR and CT images of 52 ears obtained from 26 patients with LEDS. We reviewed the clinical findings, audiology testing, and treatment results. The degree of hearing loss was classified from normal to profound, based on pure tone audiometry. The largest areas were measured at each endolymphatic duct and analyzed to determine whether a correlation exists with the degree of hearing loss. We also analyzed the differences in measurements between CT and MRI findings. RESULTS: All 26 patients had some degree of sensorineural hearing loss, which resulted in 18 ears to undergo a cochlear implantation. One patient was diagnosed with Cornelia de Lange syndrome. Five patients had a sudden hearing loss onset. Ten ears had incomplete cochlear partitions, whereas 28 ears had enlarged vestibules. All patients had severe to profound hearing loss. We found no statistical correlation between the size of the largest area of the endolymphatic duct and the degree of hearing loss. The mean area of the endolymphatic ducts, as per an MRI examination, revealed slightly greater areas than the CT findings, although the differences were not significant. CONCLUSION: Enlarged vestibules and incomplete partitions of the cochlea were common anomalies associated with LEDS. We found no statistical correlation between the largest area of the endolymphatic duct or sac with the degree of hearing loss.
Audiology ; Audiometry ; Cochlea ; Cochlear Implantation ; Cochlear Implants ; De Lange Syndrome ; Ear ; Ear, Inner ; Endolymphatic Duct ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Retrospective Studies

PURPOSE: To determine the associated diseases causing hepatic capsular enhancement and analyze the relationship of the capsular enhancement patterns as a function of the associated diseases. MATERIALS AND METHODS: We retrospectively reviewed 797 patients having undergone arterial phase abdominal CT scans. Among these images, 47 patients showed hepatic capsular enhancement (13 men and 34 women; mean age: 53.1; age range: 5-91 years). We investigated if there was a correlation between the pattern of hepatic capsular enhancement and cause of disease. When the hepatic capsular enhancement was found to persist until the portal phase, the symptom duration was evaluated. RESULTS: Hepatic capsular enhancements were presented in 5.9% (47/797) of the arterial phase abdominal CT scans. Six patients (12.8%) were diagnosed with Fitz-Hugh-Curtis syndrome. The other causes of hepatic capsular enhancement included 20 cases of inflammation, 13 cases of malignancy, and 8 cases of other diseases. The extent of the hepatic capsular enhancement was not significantly different among the causes of disease. In thirty two of 47 patients (68.1%), hepatic capsular enhancement persisted until the portal phase images. CONCLUSION: Hepatic capsular enhancement on an arterial phase is a nonspecific imaging finding observed in the Fitz-Hugh-Curtis syndrome as well as a variety of other diseases. A CT is useful in finding the hepatic capsular enhancement and determining the accompanying disease.
Chlamydia Infections ; Female ; Hepatitis ; Humans ; Inflammation ; Liver ; Male ; Multidetector Computed Tomography ; Pelvic Inflammatory Disease ; Peritonitis ; Retrospective Studies

No abstract available.
Hydrocephalus, Normal Pressure ; Myotonic Dystrophy