No abstract available.
Diffusion* ; Humans ; Oculomotor Nerve*

PURPOSE: The ascending reticular activating system (ARAS) is responsible for regulation of consciousness. In this study, using diffusion tensor imaging (DTI), we attempted to reconstruct the thalamocortical projections between the intralaminar thalamic nuclei and the frontoparietal cortex in normal subjects. METHODS: DTI data were acquired in 24 healthy subjects and eight kinds of thalamocortical projections were reconstructed: the seed region of interest (ROI) - the intralaminar thalamic nuclei and the eight target ROIs - the medial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, orbitofrontal cortex, premotor cortex, primary motor cortex, primary somatosensory cortex, and posterior parietal cortex. RESULTS: The eight thalamocortical projections were reconstructed in each hemisphere and the pathways were visualized: projections to the prefrontal cortex ascended through the anterior limb and genu of the internal capsule and anterior corona radiata. Projections to the premotor cortex passed through the genu and posterior limb of the internal capsule and middle corona radiata; in contrast, projections to the primary motor cortex, primary somatosensory cortex, and posterior parietal cortex ascended through the posterior limb of the internal capsule. No significant difference in fractional anisotropy, mean diffusivity, and fiber volume of all reconstructed thalamocortical projections was observed between the right and left hemispheres (p>0.05). CONCLUSION: We reconstructed the thalamocortical projections between the intralaminar thalamic nuclei and the frontoparietal cortex in normal subjects. We believe that our findings would be useful to clinicians involved in the care of patients with impaired consciousness and for researchers in studies of the ARAS.
Anisotropy ; Brain* ; Cerebral Cortex* ; Consciousness ; Diffusion Tensor Imaging ; Extremities ; Healthy Volunteers ; Humans* ; Internal Capsule ; Intralaminar Thalamic Nuclei* ; Motor Cortex ; Parietal Lobe ; Prefrontal Cortex ; Somatosensory Cortex ; Thalamus

No abstract available.
Humans

The demand for hospitalists is increasing due to decreasing numbers of clinical residents and increased concerns regarding patient safety. However, several limitations in the surgical hospitalist role exist. The personnel of the surgical hospitalist, rapid response team (RRT), surgical critical care, and trauma surgery teams were unified under the admission, critical care, and trauma surgery (ACTs) team at this institution. The ACTs target are patients with severe disease not undergoing general postoperative course, or patients with the potential for severe conversion. Two surgical intensivists are on duty once a week and oversee the intensive care unit (ICU), the back-up treatment of critically ill patients, and the immediate treatment of trauma patients. ACTs also participate in the surgical RRT and select patients with a high probability of severe exacerbation. Between 2019-2021, the cardiopulmonary resuscitation incidence per 1,000 hospitalized patients in the surgical department decreased significantly from 0.81 to 0.55. From March to December 2021, the ACTs team were involved with 101 of 158 surgical patients admitted to the ICU: 62 with postoperative status, 29 with severe trauma, and 10 transferred to the ICU via RRT screening. Based on our experience, the role of the ACTs team can help improve patient safety.

A thyroid storm is a rare complication of hyperthyroidism. Although a thyroid storm rarely presents with symptoms similar to those of an acute abdomen, and in cases where emergency surgery is needed, the thyroid function test is not performed routinely. In this study, we report a case in which hyperthyroidism was diagnosed after surgery in a patient with recurrent refractory peptic ulcer disease. Although peptic ulcer disease and hyperthyroidism rarely coexist, when the patient's initial condition was reviewed in the Emergency Department, the findings were reasonable for panperitonitis due to peptic ulcer perforation, which is considered as a condition suitable for a thyroid storm. This isolated case indicates a logical leap in the correlation between peptic ulcer and thyroid storm. In recurrent refractory peptic ulcer disease, the thyroid function test may be helpful as a routine laboratory test before emergency surgery.

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) may be observed in various types of cancer, but is mainly seen in small-cell carcinoma. It can also be caused by several chemotherapeutic agents. However, it is a very rare phenomenon in esophageal cancer or its treatment. We report here on a case of SIADH related to esophageal cancer treatment. A 55-year-old man received chemoradiotherapy (CRT) for esophageal cancer. After receiving CRT for 5 days, he complained of nausea, dizziness, and general weakness, and his sodium level had dropped to 107 mEq/L. His volume status was clinically euvolemic and there were no edema or pigmentation. After hypertonic saline infusion, the sodium level increased and the symptoms improved. There have been several reports of SIADH associated with malignancies or chemotherapy agents. However, to the best of our knowledge, this is the first Korean case of SIADH associated with esophageal cancer that occurred after cisplatin treatment.
Chemoradiotherapy ; Cisplatin ; Dizziness ; Drug Therapy ; Edema ; Esophageal Neoplasms* ; Humans ; Inappropriate ADH Syndrome ; Middle Aged ; Nausea ; Pigmentation ; Sodium

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.
Adenomyosis ; Cervical Intraepithelial Neoplasia ; Colpotomy ; Endometriosis ; Female ; Fistula ; Humans ; Hysterectomy* ; Ileus ; Leiomyoma ; Length of Stay ; Sutures ; Thrombophlebitis ; Ureter ; Urinary Bladder

OBJECTIVES: The objective of this study is to identify alcohol pharmacokinetics and to investigate the correlations between various factors for alcohol metabolism of healthy Korean males. METHODS: The 101 recruited volunteers were randomized into two groups as one group provided 0.35 mg/mL/kg and 0.7 mg/mL/kg, the other. Blood alcohol concentration was measured and analyzed in enzymatic methods eight times from drinking point. RESULTS: Alcohol elimination rate (beta) was found to be -0.0083%/h for low dose group and -0.0157%/h for the high dose group. The results indicate discrepancy in the legal criteria of alcohol elimination rate (-0.008%/h). The measured alcohol pharmacokinetic properties were following : mean time to reach maximum alcohol concentration in blood was 30 minutes, absorption rate was 0.0197%, maximum alcohol concentration in blood was 0.4930%, and Area under the curve was 59.25. Also, alcohol elimination was not affected by age, smoking, total body water, drinking capacity, body mass index, blood cholesterol, body fat, and body fat ratio. CONCLUSION: These results suggest that legal limitation could be adjusted in Korean males. Also the research should be extended including female and senior citizens for statistical significance of the research. These findings have contributed to our knowledge of the alcohol pharmacokinetics in Korean male.
Absorption ; Adipose Tissue ; Adult* ; Body Mass Index ; Body Water ; Cholesterol ; Drinking ; Female ; Humans ; Male* ; Metabolism ; Pharmacokinetics* ; Smoke ; Smoking ; Volunteers

Purpose: A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. Methods: There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. Results: All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). Conclusion The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients. Methods: This was a retrospective study of confirmed COVID-19 patients (N = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death. Results: In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, p = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (p < 0.001). Conclusion Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.