PURPOSE: To decrease the high negative appendectomy rate, in addition to the traditional history-taking, physical examination, and laboratory findings, additional sensitive and specific examinations are necessary. The authors conducted a study to evaluate the value of ultrasonographic examination in the diagnosis of acute appendicitis in patients with clinically suspected appendicitis. METHODS: During 18 months from July 1, 1998 through December 31, 1999, a total of 290 patients were enrolled into the study. Altogether 110 abdominal sonographic examinations were performed by the staff radiologist, in all cases of clinically suspected appendicitis. The improvement of diagnostic accuracy was compared with the historical control group of 240 patients during the period of 18 months from January 1, 1997 through June 30, 1998. RESULTS: Clinical diagnosis (without sonographic examination) was made in 180 patients (157 appendicitis, and 23 non-appendicitis). Negative appendectomy was performed in 24 patients. Sonographic diagnosis was made in 110 patients with clinically suspected appendicitis (91 appendicitis, and 19 non-appendicitis). Negative appendectomy was done in 9 patients. Nineteen patients without positive sonographic findings of appendicitis could be spared the negative appendectomy. Abdominal sonography for detecting acute appendicitis had a sensitivity of 100.0%, a specificity of 67.9%, an accuracy of 91.0%, a positive predictive value of 90.1%, and a negative predictive value of 100.0%. By adding ultrasonographic examinations in all cases of clinically suspected appendicitis, diagnostic specificity was increased significantly over the historical control group (P<0.01). CONCLUSIONS: Although the value of meticulous history- taking, physical examination, and laboratory tests cannot be overemphasized, our experience suggests that patients with clinically suspected appendicitis should routinely undergo abdominal sonographic examinations, performed by experienced radiologists and surgeons, to further decrease the negative appendectomy rates.
Appendectomy ; Appendicitis* ; Diagnosis ; Humans ; Physical Examination ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

Choledochal cyst is a relatively rare disease entity considered to be a congenital cyatic dilatation of the common bile duct. Since occurrence of malignant tumor in choledochal cyet was first reported by Irwin and Morrison in 1944, approximately 100 more cases of malignant tumors arising in congenital choledocal cyst have been reported in the world, and the risk of malignant tumor related to choledochal cyst have been reported 2.4-14%. Recently, we experienced a case of adenocarcinoma arising in choledochal cyst in 39 year-old woman who was diagnosed by ERCP and cholangioscopy with forceps biopsy, and was treated with en bloc resection of the choledochal cyst along with the pancreatic head and duodenum.
Adenocarcinoma ; Adult ; Bile Duct Neoplasms ; Biopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Dilatation ; Duodenum ; Female ; Head ; Humans ; Rare Diseases ; Surgical Instruments

Choledochal cyst is a relatively rare disease entity considered to be a congenital cyatic dilatation of the common bile duct. Since occurrence of malignant tumor in choledochal cyet was first reported by Irwin and Morrison in 1944, approximately 100 more cases of malignant tumors arising in congenital choledocal cyst have been reported in the world, and the risk of malignant tumor related to choledochal cyst have been reported 2.4-14%. Recently, we experienced a case of adenocarcinoma arising in choledochal cyst in 39 year-old woman who was diagnosed by ERCP and cholangioscopy with forceps biopsy, and was treated with en bloc resection of the choledochal cyst along with the pancreatic head and duodenum.
Adenocarcinoma ; Adult ; Bile Duct Neoplasms ; Biopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Dilatation ; Duodenum ; Female ; Head ; Humans ; Rare Diseases ; Surgical Instruments

Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. The morphology is similar to that of immature Ganoderma lucidum, making identification difficult for non-experts. We experienced such a case of a 56- year-old male who picked and consumed podostroma cornu-damae, and consumed. Later that day, he developed digestive system symptoms, including nausea, vomiting, and abdominal pain. He presented to the emergency room (ER), there were no abnormal physical findings, symptoms improved after gastric lavage, and the patient voluntarily discharged himself on the same day. The following day, as the symptoms gradually deteriorated, he was admitted via the ER. He was presented with severe pancytopenia, alopecia, desquamation of skin, and acute renal failure. He recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most commonly reported complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. since Prevention is especially important because its toxicity can be lethal and there is no particular treatment to date, prevention is especially important. Promotion and education for the public are needed.
Abdominal Pain ; Acute Kidney Injury ; Agaricales ; Alopecia ; Anti-Bacterial Agents ; Colony-Stimulating Factors ; Digestive System ; Disseminated Intravascular Coagulation ; Education ; Emergency Service, Hospital ; Fruit ; Fungi ; Gastric Lavage ; Granulocytes* ; Humans ; Male ; Mycotoxins ; Nausea ; Pancytopenia* ; Reishi ; Skin* ; Vomiting

PURPOSE: Raman spectroscopy is a vibrational spectroscopic technique, which is capable of providing details on the chemical composition, molecular structure and molecular interactions in cells and tissues. The primary objective of this study was to explore Raman spectroscopy for the detection of spectral changes between normal and cancer tissue in the stomach. METHODS: Tissue specimens were obtained from the resected stomach of advanced gastric cancer patients. The normal gastric and cancer tissues were harvested from the middle, lower portion of the stomach and from the tumor mass, respectively. 19 sets (antrum, body and cancer) of spectral data, with clearly defined histopathological findings, were selected in this study. FT-Raman spectroscopy (Bruker Inc., Karsruhe, Germany) was used for tissue Raman studies, with excitation at 1, 064 nm. The Raman spectra from the gastric tissue specimens were obtained with a 20 minute signal acquisition time. RESULTS: In the range 700~1, 900 cm-1, the Raman spectra of gastric antral tissue were dominated by a number of vibrational modes of biomolecules, such as proteins, lipids and nucleic acids. The Raman spectrum pattern of gastric body tissue was similar to that of the antrum, suggesting the structure and composition between the gastric antrum and body are much the same. The Raman spectra differed significantly between the normal and malignant cancer tissues, with cancers showing higher percentage signals for protein, lipid and nucleic acid compared to normal tissue (P<0.05). Difference were observed in the shapes of the Raman spectra between the normal and cancer tissues, particularly in the spectral ranges 1, 250~1, 255, 1, 330~1, 340 and 1, 440~1, 450 cm-1, which contain signals relating to protein and lipid conformations and CH2 bending mode of nucleic acids. CONCLUSION: This study demonstrates the ability of Raman spectroscopy to detect biochemical changes in malignant gastric tissue, and may become a useful adjunct to pathological diagnosis allowing guided biopsies and assessment of adequacy of resection margins.
Biopsy ; Diagnosis ; Humans ; Molecular Structure ; Nucleic Acids ; Pyloric Antrum ; Spectrum Analysis ; Spectrum Analysis, Raman* ; Stomach Neoplasms ; Stomach*

PURPOSE: The purpose of this study was to assess the usefulness of multiplanar reconstruction (MPR) images in the preoperative evaluation of advanced gastric cancer. METHODS: Multidetector-row CT (MDCT) was performed on 61 patients with advanced gastric cancer, and the coronal and sagittal multiplanar images reconstructed from the transaxial data. The combined axial and MPR images were compared to the axial images alone to determine if the image quality and diagnostic accuracy had been improved. RESULTS: The observed image quality of the combined axial and MPR images, graded relative to the axial image alone, was fair in 22 (36.1%), good in 27 (44.2%), and excellent in 12 cases (19.7%). For the T staging, the diagnostic accuracy of combining the axial and MPR images (75.4%) was higher than that of the axial image alone (70.7%). However, there was no significant difference in the accuracies between the two methods (McNeamar test, P>0.05). For specific regions, the diagnostic accuracies of combining the axial and MPR images and the axial image alone were as follows: 90.2, and 73.8% with antral lesser curvature involvement; 93.4, and 75.4% with antral greater curvature involvement; 83.6, and 73.8% with gastric angle involvement; 96.7, and 88.5% with liver left lobe invasion; 90.2, and 83.6% with pancreas head invasion and 96.7, and 85.2% with colon or mesocolon invasion, respectively. CONCLUSION: Combining the axial and MPR images does not improve the depiction of the T staging compared to the axial image alone in advanced gastric cancer. However, combining the axial and MPR images improved the imaging quality and diagnostic accuracy of specific regions where the delineation of the conventional axial image was insufficient. Therefore, combining the axial and MPR images may be very useful in the preoperative evaluation of advanced gastric cancers.
Colon ; Head ; Humans ; Liver ; Mesocolon ; Pancreas ; Stomach Neoplasms*

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke