BACKGROUND: Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. METHODS: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. RESULTS: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). CONCLUSIONS: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.
Acute Kidney Injury* ; Body Mass Index* ; Classification ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Liver Transplantation* ; Liver* ; Logistic Models ; Mortality ; Retrospective Studies* ; Thinness

PURPOSE: We evaluated the correlation between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus. MATERIALS AND METHODS: The 28 cases (20 patients) with moderate to severe hallux valgus deformity and pain of the first metatarsophalangeal joint who underwent the distal soft tissue procedure and proximal metatarsal closing wedge osteotomy, were divided into two groups, Group I: no pain of the first metatarsophalangeal joint after surgery, and Group II: with persisting pain. We analyzed the correc-tion angle and pain of the first metatarsophalangeal joint in each group, preoperatively and at the last follow-up. All of the patients were women and their mean age was 58 years old. The average follow-up time was 18 months. RESULTS: At the last follow-up, the 21 feet (75%) were free of pain of the first metatarsophalangeal joint. In 7 feet (25%) pain persisted. In group I, sufficient deformity correction was obtained, but in group II, the deformity was corrected insufficiently. A high correlation was observed between correction angle and pain relief. CONCLUSION: A high correlation was obtained between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus deformity. Therefore, in view of the patient's expectation of pain relief, meticulous attention should be paid to the correction of hallux valgus deformity.
Congenital Abnormalities ; Female ; Follow-Up Studies ; Foot ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint* ; Middle Aged ; Osteotomy

OBJECTIVE: The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC). METHODS: Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC. RESULTS: When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation. CONCLUSION: These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.
Amygdala ; Brain* ; Autism Spectrum Disorder* ; Child* ; Cognition ; Humans ; Limbic System ; Magnetic Resonance Imaging* ; Mirror Neurons

PURPOSE: The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. MATERIALS AND METHODS: In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. RESULTS: The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. CONCLUSIONS: We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.
Critical Pathways ; Gastrectomy ; Humans ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The pharyngeal flap is one of the popular surgical methods to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcome of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. METHODS: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency from September 1996 to January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. RESULTS: The mean score of preoperative speech was 52.6 +/- 7.4 points and postoperative speech was 58.6 +/- 6.5 points, which presented significant postoperative speech improvement with an average of 5.9 points (p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree (p<0.01, r=-0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement (p<0.01). CONCLUSION: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than 5 years of age.
Follow-Up Studies ; Humans ; Velopharyngeal Insufficiency

PURPOSE: Endoscopic transnasal correction of the medial orbital fractures cannot be enable to confirm the reduction degree of orbital volume without imaging modalities. We have intended through this study to make a quantative analysis of preoperative orbital volume increment and the reduction degree of that after ethmoidal sinus packing by using CT scan. METHODS: In this retrospective study, 22 patients were selected to evaluate the postoperative volume reduction, who took 2 CT scans which are pre- and postoperative under the same protocol. The postoperative CT scan was carried out in about 5 days after the operation with the packing inserted into ethmoidal sinus. The length of bony defect on each section was measured by PACS program and the area of defect was calculated by summing lengths on each section multiplied by the thickness of the section. When the outline of orbit on the slice is drawn manually with a cursor, PACS program measures the area automatically. Orbital volume was calculated from the sum of the area multiplied by the section thickness. RESULTS: The mean dimension of fractured walls was 2.86 +/-0.99 cm2. The mean orbital volume of the unaffected orbits was 22.89 +/-2.15 cm3 and that of the affected orbits was 25.62 +/-2.82 cm3. The mean orbital volume increment of the affected orbits was 2.73 +/-1.13 cm3. After surgery, the mean orbital volume of the unaffected orbits was 22.46 +/-2.73 cm3 and the mean orbital volume decrease on the surgical side was 2.98 +/-1.07 cm3. The estimated correction rate was 118.30%. CONCLUSION: The orbital volume increment in fractured orbit showed linear correlation with the dimension of fractured area. The orbital volume changes after ethmoidal sinus packing also showed linear correlation with orbital volume increment in fractured orbit. This study showed the regressive linear correlation between the increment of orbital volume and the correction rate. To evaluate the maintenance of reduction state, we think that the further study should be done for comparative analysis of orbital volume change after removal of packing.
Humans ; Orbit ; Orbital Fractures ; Retrospective Studies

PURPOSE: Under the rising demand of health services, the critical pathway (CP) which standardizes the practice guideline was introduced as a means to provide quality healthcare service. CP may increase the patient's satisfaction rate by providing systematic and consistent service. We aimed to evaluate the significance of CP by development and application of CP to patients undergoing laparoscopic cholecystectomy. METHODS: From June 2010 to July 2011, 148 patients underwent elective laparoscopic cholecystectomy. Patients were divided into two groups, including 57 patients in the CP group and 91 patients in the non-CP group. In a retrospective review, related hospital costs were analyzed and compared for both groups. Survey results on satisfaction for the CP group were also analyzed. RESULTS: The mean age was 22.7 years in the CP group and 37.9 years in the non-CP group. Number of hospitalized days was one day for the CP group and 2.51 days for the Non-CP group with p<0.001. In cost analysis all variables showed a significant reduction in the CP group compared to the Non-CP group. The satisfaction rate in the CP group scored 8 points out of 10. CONCLUSION: Results have shown benefit from the financial point of the view for the CP group. Current inclusion criteria for CP are limited and still in development for a solid protocol. Further efforts with a large-scale comparative study to broaden the indication for CP are desired.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Costs and Cost Analysis ; Critical Pathways* ; Delivery of Health Care ; Health Services ; Hospital Costs ; Humans ; Retrospective Studies

PURPOSE: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The PURPOSE of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of Medpor(R) through subciliary approach. METHODS: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. RESULTS: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. CONCLUSION: The ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach can be considered one of the appropriate technique for extensive inferior blow- out fracture.
Catheters ; Diplopia ; Enophthalmos ; Floors and Floorcoverings ; Humans ; Orbit ; Orbital Fractures ; Retrospective Studies

PURPOSE: Inferior blow-out fracture is the common facial fracture. Unsatisfactory functional and aesthetic outcomes are frequent when it is treated inappropriately. If fractures are extended and reach the posterior end of orbital floor, enophthalmos frequently followed as complication. The PURPOSE of this study was to evaluate reduction technique of extensive inferior blow-out fracture with ballooning of foley catheter through endoscopic transnasal approach and implantation of Medpor(R) through subciliary approach. METHODS: A retrospective study was performed on 14 patients with extensive inferior blow-out fracture who underwent ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach. Patients were operated from May 2005 to November 2007. Data for 14 patients were acquired from patient's charts. Preoperative and postoperative data for enophthalmos, diplopia, limitation of extraocular motion were reviewed. Preoperative and postoperative CT scan were also checked. The patients were followed up from 4 to 18 months. RESULTS: The enophthalmos was corrected in all patients. Among 7 patients with diplopia preoperatively, diplopia was resolved in three patients postoperatively. The diplopia persisted in four patients and two of them also had limitation of extraocular motion postoperatively. The limitation of extraocular motion occurred in seven patients preoperatively. But five patients recovered after operation immediately. These symptoms were resolved about three months after the operation. CONCLUSION: The ballooning of foley catheter through endoscopic transnasal approach with implantation of Medpor(R) through subciliary approach can be considered one of the appropriate technique for extensive inferior blow- out fracture.
Catheters ; Diplopia ; Enophthalmos ; Floors and Floorcoverings ; Humans ; Orbit ; Orbital Fractures ; Retrospective Studies

OBJECTIVE: Because of the limited penetration into the central nervous system after systemic administration of numerous therapeutic compounds, intratumoral chemotherapy for brain tumors has also been used. However, the efficacy of intratumoral drug administration is restricted by the poor diffusion of drug through tumor and brain interstitium. In order to enhance the diffusion of chemotherapeutic agent and increase the cytotoxicity with minimal dose, the authors report the results of convection-enhanced delivery(CED) of chemotherapeutic agent to the malignant brain tumor as a method of enhancing cerebral drug delivery. METHODS: Authors used "CADD-Micro(R) ambulatory infusion pump" from Deltec, which can be programmed for continuous infusion. Intratumoral injection of chemotherapeutic drug using the pump was applied to eight patients with glioma and one patient with lymphoma. Surgery was done and tumor was removed as much as possible. The tip of catheter was placed in the center of tumor cavity. Adriamycin (0.16~0.32mg) was put in the reservoir which was connected to the proximal catheter and fixed in the pump device. Twenty-four hours after surgery, Adriamycin was infused. RESULTS: There was no adverse reaction of CED technique. Compared with current delivery techniques, the improvement of survival rate has been observed(5 patients: alive, 3 patients: dead, 1 patient: lost(alive to 5 mo.)). CONCLUSION: CED can be useful method for distributing therapeutic molecules in the interstitial space of tumor and can be utilized for chemotherapeutic agents, immunotoxins, and gene etc..
Brain ; Brain Neoplasms ; Catheters ; Central Nervous System ; Diffusion ; Doxorubicin ; Drug Therapy ; Glioma ; Humans ; Immunotoxins ; Lymphoma ; Survival Rate