PURPOSE: We attempted to evaluate the outcomes of a newly inaugurated surgical technique of laparoscopic pyloromyotomy with microscope and stab incision (MS-LP) with right upper quadrant transverse open pyloromyotomy (RT-OP), which were performed in a single institution. METHODS: The outcome variables in terms of total anesthesia time, operative time, postoperative emesis, time to full-enteral feeding, postoperative hospital stay, cosmetic result score, medical cost, and postoperative wound complications were compared between the MS-LP and RT-OP groups. RESULTS: Fifty-one consecutive pyloromyotomy cases were enrolled; MS-LP (n=33) and RT-OP (n=18). There was no difference in age, pyloric thickness, and preoperative electrolyte levels between the two groups. The total anesthesia time and operative time of MS-LP were not significantly longer than that of RT-OP. Time to full-enteral feeding and postoperative hospital stay were shorter in MS-LP (20.0±18.3 vs. 35.3±14.8 hrs. and 2.4±1.3 vs. 3.4±1.2 days; p=0.047 and 0.050, respectively). The cosmetic result score and medical cost were significantly higher in MS-LP (9.1±1.0 vs. 7.3±1.2 in terms of scores and 3,501,950±1,093,147 vs. 2,522,474±68,605 in terms of KRW; p=0.001 and 0.021, respectively). No difference in postoperative wound complications was observed between the two groups. CONCLUSION: Laparoscopic pyloromyotomy with microscope and stab incision may suggest recovery benefits with a shorter time to full-enteral feeding and postoperative hospital stay, as well as better cosmetic results than RT-OP. However, MS-LP may induce higher costs.
Anesthesia ; Length of Stay ; Operative Time ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic* ; Wounds and Injuries

PURPOSE: Currently the substantial clinical benefits of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) are equivocal. The aim of this study was to compare surgical outcomes between SLA and CLA in children with acute appendicitis. METHODS: A single blind prospective randomized single center study was performed to compare the surgical outcomes of SLA and CLA. A total of 105 patients were randomized and various parameters were analyzed, 52 patients with SLA and 53 patients with CLA between July 2013 and March 2014. Patients with sonographically confirmed acute appendicitis were randomly assigned to receive either SLA or CLA. The outcome measurements were operating time, wound complication, and intraperitoneal morbidities, postoperative pain score and cosmetic result score. RESULTS: Operating time is significantly longer in SLA (70.4+/-26.7 minutes vs. 58.0+/-23.4 minutes; p=0.016). There were no significant differences in the postoperative wound complication rate and intraperitoneal morbidities between two groups. There were no significant differences in postoperative resting pain score (6.6+/-2.5 vs. 6.3+/-2.5; p=0.317) and activity pain score (6.9+/-2.4 vs. 6.3+/-2.5; p=0.189), and the cosmetic result score (9.2+/-1.1 vs. 9.1+/-1.4; p=0.853). CONCLUSION: Although SLA would be a safe and feasible procedure in children, SLA could not demonstrate the clear benefit over CLA.
Appendectomy* ; Appendicitis ; Child* ; Humans ; Pain, Postoperative ; Prospective Studies* ; Wounds and Injuries

PURPOSE: Febrile convulsions are classified into simple or complex types, the latter being characterized by increased risk of recurrence and progression to epilepsy. This study aimed to delineate the clinical characteristics of complex febrile convulsions. METHODS: Between January 2003 and December 2006, 550 children were diagnosed with febrile convulsions at the Department of Pediatrics, Ilsan Paik Hospital. Their medical records were retrospectively reviewed for comparison between simple and complex febrile convulsions, and clinical findings of complex febrile convulsions were clarified. RESULTS: Our subjects comprised a male-to-female ratio of 1.64:1; the age range was from 8 months to 8 years. Simple febrile convulsions comprised 432 cases, i.e., 4 times as many as complex febrile convulsions (118 cases). The causes of febrile illness included acute pharyngotonsillitis (357 cases, 64.9%), pneumonia (55 cases, 10.0%), acute gastroenteritis (37 cases, 6.7%), and otitis media (20 cases, 3.6%). We did not find any significant difference between simple and complex febrile convulsions in most clinical parameters such as gender, age, family history of febrile convulsions, and cause of febrile illness. Regarding subtypes of complex febrile convulsions, repeated convulsions were the most frequent (72.0%), followed by prolonged convulsions (16.9%) and focal convulsions (5.1%). CONCLUSION: We have reported here the clinical features of complex febrile convulsions. Although the results did not show any significant difference between simple and complex febrile convulsions in most clinical parameters such as gender, age, family history of febrile convulsion, and cause of febrile illness, further studies are essential to delineate complex febrile convulsions.
Child ; Epilepsy ; Gastroenteritis ; Humans ; Medical Records ; Otitis Media ; Pediatrics ; Pneumonia ; Recurrence ; Retrospective Studies ; Seizures ; Seizures, Febrile

The incidence of pulmonary leiomyosarcoma as primary lung tumor is very rare. Most of the primary leiomyosarcomas originate in the hilar region in relation to the main bronchus or pulmonary vessels and only a few originate more peripherally. This rare tumor can mimic bronchial carcinoma and present with local or systemic symptoms, or it may be discovered as an incidental finding on a routine chest X-ray. We report with review of literature, a case of incidental primary pulmonary leiomyosarcoma which originated peripherally. Huge mass was found on the left lung of a 61-year-old man on the chest X-ray peripherally. He underwent the surgical resection of the left pneumonectomy and the postoperative course was uneventful.
Bronchi ; Carcinoma, Bronchogenic ; Humans ; Incidence ; Incidental Findings ; Leiomyosarcoma* ; Lung ; Middle Aged ; Pneumonectomy ; Thorax

To combat the associated pandemics of obesity and type 2 diabetes mellitus, clinicians need every tool they can get. Currently, bariatric/metabolic surgery is widely accepted as the most effective treatment for weight loss and glycemic control. Nonetheless, the impact noted in clinical studies seems to have predominantly been on the numerical reductions of bodyweight and blood glucose level after surgery. Past and recent evidence about the role of bariatric surgery in the different stages of the clinical course of type 2 diabetes were presented in this paper. Given the evidence on the efficacy of bariatric surgery for obese patients with type 2 diabetes ranging from pre-diabetes through a long-standing diabetic state with established or end-stage macro- and micro-vascular complications, the overall conclusions are that end organ damage is expected to either stabilize or improve postoperatively in most cases. However, some of these clinical outcomes have not been assessed with a robust method, and many cases are not supported by randomized clinical trials. Available evidence strongly advocates in favor of bariatric surgery in the early phase of this course, possibly in the pre-diabetic or very early diabetic stages. To reserve surgery to more advanced and complicated stages of the disease seems to confer fewer benefits in the clinical course of diabetes and might expose these more frail patients to the possible side effects of a rapid weight loss.
Bariatric Surgery ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Humans ; Obesity ; Pandemics ; Weight Loss

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.
Thyroid Function Tests ; Methimazole/therapeutic use ; Insulin/therapeutic use ; Hyperthyroidism/*complications/therapy ; Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology ; Humans ; Graves Disease/*complications ; Fluid Therapy ; Female ; Diabetes Mellitus, Type 2/*complications ; Adult