Hernias through the broad ligament are rare with a reported incidence of only 4-7% of cases of internal hernias. Here, we report on a rare case of incarcerated internal hernia through a spontaneous defect in the broad ligament which was repaired using a laparoscopic technique. A 41-year-old female was admitted with colic abdominal pain. Laparoscopic exploration was performed for the diagnosis of intestinal obstruction. Laparoscopic examination confirmed an approximately 10-cm-long ileal loop herniated in the anterior to posterior direction through a left broad ligament defect. A large defect in the broad ligament was closed by an intracorporeal continuous running suture. The patient was highly satisfied with the cosmetic result. In conclusion, laparoscopy could be particularly helpful during pelvic surgery, which usually requires large skin incisions to ensure a good field of view. This approach was cosmetically effective, decreased the postoperative complications, and promoted early recovery to usual activity.
Abdominal Pain ; Adult ; Broad Ligament* ; Colic ; Diagnosis ; Female ; Hernia* ; Humans ; Incidence ; Intestinal Obstruction ; Laparoscopy* ; Postoperative Complications ; Running ; Skin ; Sutures

A recent widespread concept is that ultrasound-guided central venous catheter insertion is a mandatory method. Some techniques have been introduced for ultrasound-guided central venous catheterization. Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access. Therefore, we used this technique for the insertion of a large-bore cuffed tunneled dual-lumen catheter for hemodialysis. Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle. Using this approach, we can reduce the possible complications of pinching and kinking of the catheter.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Jugular Veins* ; Neck ; Punctures ; Renal Dialysis* ; Skin ; Ultrasonography

OBJECTIVE: A tablet device has several medical applications because it's portability. Most importantly, its powerful graphics and touch-based features have several benefits in the surgical field, especially for generating three-dimensional (3D) images based on patients' computed tomography (CT) scans. METHODS: In this study, 3D objects were manipulated by an operator on an iPad during several laparoscopic surgeries of intra-abdominal organs. Before surgery, 3D structures, such as vessels, soft tissues, and bones, were reconstructed by the surgeon using the patients' CT scans on the patients' bed-side personal computer. RESULTS: In this study, 3D image-guided surgeries were performed using an iPad in five patients. The benefits of this technique were recorded and analyzed in detail by the surgeon. CONCLUSION: Although in a pilot phase with unresolved issues, direct intra-operative handling of a patient-tailored 3D model developed using a tablet device could be useful compared with conventional two-dimensional imaging.
Humans ; Laparoscopy ; Microcomputers ; Surgery, Computer-Assisted* ; Tomography, X-Ray Computed

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.
Catheters ; Femoral Vein ; Humans ; Jugular Veins ; Methods ; Renal Dialysis ; Subclavian Vein ; Upper Extremity ; Veins

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Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Objective: Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods: Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results: We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.

Objective: Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods: Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results: We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.

Objective: Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods: Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results: We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.