1.Perioperative Outcomes of Different Surgical Methods Among Bladder Cancer Patients Undergoing Radical Cystectomy With Neobladder Urinary Diversion
Hak Ju KIM ; Changhee YE ; Jin Hyuck KIM ; Hwanik KIM ; Sangchul LEE ; Seok-Soo BYUN ; Jong Jin OH
Korean Journal of Urological Oncology 2021;19(4):261-270
Purpose:
To compare perioperative outcomes according to surgical methods among bladder cancer patients who underwent radical cystectomy (RC) with neobladder urinary diversion.
Materials and Methods:
Between June 2007 and January 2020, 89 bladder cancer patients who received RC with neobladder urinary diversion were enrolled in this study. Patients were stratified into surgical methods – (1) open RC with neobladder (ONB) reconstruction, (2) robotassisted RC (RARC) with extracorporeal neobladder (ECNB) reconstruction, and (3) RARC with intracorporeal neobladder (ICNB) reconstruction. Perioperative outcomes were compared among the 3 groups, with major complications defined according to Clavien-Dindo grades III–V within 90 days. Logistic regression analysis was performed to identify significant factors for postoperative complications.
Results:
Of 89 patients, 28 (31%) had ONB, 31 (35%) had ECNB, and 30 (34%) had ICNB. The median operative time was 471 minutes, and the ICNB group (424.5 minutes) was significantly less than ONB (444.5 minutes) and ECNB groups (542.9 minutes) (p=0.001). Transfusion rate was also significantly less in the ICNB group (13%) (p=0.001). Complications were recorded in 67 patients (75%) and major complications in 22 of all patients (25%). The major complication rate was significantly less in ICNB (13.4%) than in ONB (25%) and ECNB (35%) (p=0.003). Multivariate analysis showed surgical methods (ICNB) (odds ratio [OR], 0.709; p=0.003) and age (OR, 1.150; p=0.001) were significant factors related to occurrence of major postoperative complications.
Conclusions
RARC with ICNB reduces postoperative complications compared to ONB and ECNB.
2.Brain magnetic resonance imaging (MRI) findings in central precocious puberty patients: is routine MRI necessary for newly diagnosed patients?
Ye Rim OH ; Yu Jin KIM ; Kyeong Eun OH ; Gyu Hyun PARK ; Eungu KANG ; Hyo-Kyoung NAM ; Young-Jun RHIE ; Saelin OH ; Kee-Hyoung LEE
Annals of Pediatric Endocrinology & Metabolism 2023;28(3):200-205
Purpose:
The overall incidence of central precocious puberty (CPP) has increased in recent decades, and brain magnetic resonance imaging (MRI) evaluations are recommended in cases of suspected brain lesions. This study aimed to investigate the prevalence of MRI abnormalities and to evaluate the need for routine brain MRI in patients with newly diagnosed CPP.
Methods:
This retrospective study reviewed the data of patients newly diagnosed with CPP who underwent routine pituitary MRI at Korea University Anam Hospital from March 2020 to September 2021. A total of 199 girls and 24 boys was enrolled in this study. Positive MRI findings were categorized as abnormal pituitary, nonpituitary incidental, and pathological. In addition, we investigated the incidence of MRI abnormalities and evaluated their associations with clinical and biochemical factors.
Results:
Positive brain MRI findings were observed in 84 patients (37.7%). Pituitary abnormalities were found in 54 patients (24.2%), with Rathke cleft cysts being the most common (16.1%). Incidental nonpituitary findings were observed in 29 patients (13.0%), while a pathological brain lesion (diagnosed as hypothalamic hamartoma) was observed in only 1 female patient (0.4%). No significant differences in sex or age were found in incidence of pituitary abnormalities or nonpituitary incidental findings. Compared with headache controls, significant associations were observed between abnormal pituitary findings on MRI and CPP (unadjusted odds ratio, 3.979; 95% confidence interval, 1.726–9.173).
Conclusion
True pathological findings were rare, even though the prevalence of abnormalities on pituitary MRI in patients with CPP was relatively high. Considering its cost-effectiveness, MRI screenings should be carefully considered in patients with CPP.
3.Natural Killer-cell Enteropathy of the Stomach in an Elderly Woman: A Case Report
Ye young KOO ; Jin LEE ; Bomi KIM ; Su Jin JEONG ; Eun Hye OH ; Yong Eun PARK ; Jongha PARK ; Tae Oh KIM
The Korean Journal of Gastroenterology 2021;78(6):349-352
Natural killer (NK) cell enteropathy is not well understood. Although NK-cell enteropathy is typically benign, aggressive NK-cell lymphoma is an important differential diagnosis. This paper reports a rare case of NK-cell enteropathy of the stomach presenting with dyspepsia and weight loss. In this case, upper endoscopy revealed an ulcer-like lesion (approximately 7 mm) surrounded by erythema, edema, and mucosal hemorrhage. The biopsy revealed atypical lymphocyte cells expressing CD56 without an Epstein-Barr virus infection, which is consistent with NK-cell enteropathy. Follow-up endoscopy 2 months later revealed lesion regression with mild erythema. The patient was observed closely for 6 months, with no evidence of lymphoma.
4.The corrected QT (QTc) prolongation in hyperthyroidism and the association of thyroid hormone with the QTc interval.
Ye Seung LEE ; Joong Wan CHOI ; Eun Ju BAE ; Won Il PARK ; Hong Jin LEE ; Phil Soo OH
Korean Journal of Pediatrics 2015;58(7):263-266
PURPOSE: Ventricular repolarization is assessed using the QT interval corrected by the heart rate (QTc) via an electrocardiogram (ECG). Prolonged QTc is associated with an increased risk of arrhythmias and cardiac mortality. As there have been few reports regarding the effects of hyperthyroidism on ventricular repolarization, we studied the association between serum free thyroxine (free T4 [fT4]) and thyroid stimulating hormone (TSH) levels and the QTc interval. METHODS: Thirty-eight patients with hyperthyroidism (<30 years old) were included, and we used their clinical records and available ECGs (between August 2003 and August 2011) to evaluate the association between their fT4 and TSH levels and their QTc interval. In addition, we studied the ECGs of 72 age-matched patients with no hyperthyroidism (control group) and compared their data with that from the patients group. RESULTS: The QTc duration in patients with hyperthyroidism was significantly prolonged compared to that in the control subjects (P<0.001). In addition, the number of hyperthyroid patients with abnormal prolonged QTc was significantly higher than that in the control group (P<0.001). Among the patients with hyperthyroidism, patients with prolonged QTc and borderline QTc had higher fT4 levels and there was positive correlation between their fT4 levels and their QTc interval (P<0.05). However, no correlation was observed between their TSH levels and their QTc interval. CONCLUSION: We report that hyperthyroidism is associated with QTc prolongation. The correlation between the fT4 levels and the QTc interval suggests that thyroid status is associated with QTc values and the risk of cardiac mortality.
Arrhythmias, Cardiac
;
Electrocardiography
;
Heart Rate
;
Humans
;
Hyperthyroidism*
;
Long QT Syndrome
;
Mortality
;
Thyroid Gland*
;
Thyrotropin
;
Thyroxine
5.Comparison of Invariant NKT Cells with Conventional T Cells by Using Gene Set Enrichment Analysis (GSEA).
Sae Jin OH ; Ji Ye AHN ; Doo Hyun CHUNG
Immune Network 2011;11(6):406-411
BACKGROUND: Invariant Natural killer T (iNKT) cells, a distinct subset of CD1d-restricted T cells with invariant Valphabeta TCR, functionally bridge innate and adaptive immunity. While iNKT cells share features with conventional T cells in some functional aspects, they simultaneously produce large amount of Th1 and Th2 cytokines upon T-cell receptor (TCR) ligation. However, gene expression pattern in two types of cells has not been well characterized. METHODS: we performed comparative microarray analyses of gene expression in murine iNKT cells and conventional CD4+CD25-gammadeltaTCR- T cells by using Gene Set Enrichment Analysis (GSEA) method. RESULTS: Here, we describe profound differences in gene expression pattern between iNKT cells and conventional CD4+CD25-gammadeltaTCR- T cells. CONCLUSION: Our results provide new insights into the functional competence of iNKT cells and a better understanding of their various roles during immune responses.
Adaptive Immunity
;
Cytokines
;
Gene Expression
;
Ligation
;
Mental Competency
;
Natural Killer T-Cells
;
Receptors, Antigen, T-Cell
;
T-Lymphocytes
6.The Study of EEG Spectrum Analysis as a Method of Monitoring the Depth of Anesthesia.
Seong Wan BAIK ; Sung Jin LEE ; Soo Young YE ; Sang Oh CHUN ; Gye Rock JEON
Korean Journal of Anesthesiology 2004;46(2):135-138
BACKGROUND: Monitoring the "depth of anesthesia" is an ongoing problem. To identify a useful parameter for determining the depth of anesthesia with enflurane, EEG data was obtained using a Physiolab 800. METHODS: Variations in EEG signals were measured and analyzed by the stage of anesthesia. EEG data was obtained from 15 patients during general anesthesia with enflurane. The EEG signal was acquired and analyzed in 5 steps (one day before anesthesia, during induction, during skin incision, at end of anesthesia, and one day after anesthesia). Fp1 electrode and the EEG data mainly from the forehead were used to determine the depth of anesthesia using EEG characteristics during enflurane anesthesia. All data were preprocessed by filtering, baseline correction and using the linear detrend method to reliable analyze of sample data in the surgical environment. Data obtained were transformed to frequency and power spectrum analysis was performed. RESULTS: alpha, beta, delta and theta waves were detected by frequency area separation and the trend of each wave was observed during each anesthesia stage. EEG data was slowed down and the theta wave ratio increased as the depth of anesthesia increased. Accordingly, spectral edge frequency (SEF) and median frequency (MF) were used as parameters to determine the depth of anesthesia. The frequencies of SEF and MF decreased during anesthesia and returned to the preanesthetic level after the cessation of anesthesia. CONCLUSIONS: Our results suggest that SEF and MF can contribute as useful parameters to determine the depth of anesthesia. Anesthetics not only affect the central nervous system, but also affect the autonomic nervous system. If the autonomic nervous system signals such as heart rate variability are taken into account, more reliable evaluations would be possible.
Anesthesia*
;
Anesthesia, General
;
Anesthetics
;
Autonomic Nervous System
;
Central Nervous System
;
Electrodes
;
Electroencephalography*
;
Enflurane
;
Forehead
;
Heart Rate
;
Humans
;
Skin
;
Spectrum Analysis*
7.A Case of Acrodermatitis Enteropathica Localized on the Hands and Feet with a Normal Serum Zinc Level.
Sung Yul LEE ; Ye Jin JUNG ; Tak Heon OH ; Eung Ho CHOI
Annals of Dermatology 2011;23(Suppl 1):S88-S90
Acrodermatitis enteropathica is classified as a congenital autosomal recessive type and an acquired transient type. This disease manifests as acral and periorificial dermatitis, alopecia, intractable diarrhea, and failure to thrive. Whereas the autosomal hereditary type is caused by malabsorption of zinc in the intestine, the acquired type is caused by low nutritional support or decreased peripheral release of zinc from blood. We experienced a case of a 5-month old, breast feeding, full-term female presenting with only acral bullous dermatitis without diarrhea, periorificial dermatitis and an abnormal serum zinc level.
Acrodermatitis
;
Alopecia
;
Breast Feeding
;
Dermatitis
;
Diarrhea
;
Failure to Thrive
;
Female
;
Foot
;
Hand
;
Humans
;
Intestines
;
Nutritional Support
;
Zinc
8.Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis.
Jin Hwan KIM ; Ye Soo PARK ; Kwang Jun OH ; Han Seok CHOI
Osteoporosis and Sarcopenia 2017;3(4):164-169
Severe osteoporosis is classified as those with a bone mineral density (BMD) T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of ‘advanced severe osteoporosis,’ which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody.
Arthroplasty
;
Bone Density
;
Congenital Abnormalities
;
Decompression
;
Femoral Neck Fractures
;
Femur
;
Fractures, Compression
;
Humans
;
Kyphoplasty
;
Osteoporosis*
;
Paralysis
;
Parathyroid Hormone
;
Spine
;
Vertebroplasty
;
World Health Organization
9.Chronic Physical Comorbidities and Total Medical Costs in Patients with Schizophrenia
Sang Uk LEE ; Ye Rin LEE ; In Hwan OH ; Vin RYU ; Ae Jin GOO ; You Seok KIM
Korean Journal of Psychosomatic Medicine 2018;26(1):26-34
OBJECTIVES: This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. METHODS: The Health Insurance Review and Assessment Service data in 2014–2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. RESULTS: It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. CONCLUSIONS: It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.
Comorbidity
;
Data Accuracy
;
Delivery of Health Care
;
Humans
;
Insurance, Health
;
Prevalence
;
Schizophrenia
10.A simple and novel equation to estimate the degree of bleeding in haemorrhagic shock: mathematical derivation and preliminary in vivo validation
Sung-Bin CHON ; Min Ji LEE ; Won Sup OH ; Ye Jin PARK ; Joon-Myoung KWON ; Kyuseok KIM
The Korean Journal of Physiology and Pharmacology 2022;26(3):195-205
Determining blood loss [100% – RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1 , Hct2 ) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2 ) – 1]. For validation, nonongoing haemorrhagic shock was induced in Sprague–Dawley rats by withdrawing 20.0%–60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct 2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2 ) – 1]. Seven rats losing 30.0%–60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2 ) – 1] + 32.8 (95% confidence interval [CI] of the slope: 3.14–8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N.Clinical validation is required before utilisation for emergency care of haemorrhagic shock.