A bezoar, a mixture of various undigested foreign substances in the gastrointestinal tract, causes intestinal obstruction at times. We report a case of non-surgical treatment in old age patient. An 89-year-old female presented with epigastric pain, general weakness, and intermittent melena for 1 month. There were episodic attacks of vomiting. An abdominal computed tomography scan showed a 5×4 cm, firm, atypically shaped mass at the stomach body and duodenal bulb with interspersed gas. Endoscopy showed a mass of fiber impacting the antrum pylorus, and the endoscopist failed to remove the bezoar at the first attempt. We subscribed olive oil for few days to make the bezoar small, and eventually, it was fragmented and removed without surgery. A phytobezoar is not uncommon disease required surgical removal if obstructive system developed.Ingestion of olive oil would be a helpful substitute for immediate operation in case of phytobezoar.

A bezoar, a mixture of various undigested foreign substances in the gastrointestinal tract, causes intestinal obstruction at times. We report a case of non-surgical treatment in old age patient. An 89-year-old female presented with epigastric pain, general weakness, and intermittent melena for 1 month. There were episodic attacks of vomiting. An abdominal computed tomography scan showed a 5×4 cm, firm, atypically shaped mass at the stomach body and duodenal bulb with interspersed gas. Endoscopy showed a mass of fiber impacting the antrum pylorus, and the endoscopist failed to remove the bezoar at the first attempt. We subscribed olive oil for few days to make the bezoar small, and eventually, it was fragmented and removed without surgery. A phytobezoar is not uncommon disease required surgical removal if obstructive system developed.Ingestion of olive oil would be a helpful substitute for immediate operation in case of phytobezoar.

In the article, the ‘Class’ of skeletal malocclusion was misprinted as ‘class’ in the main text. The publisher would like to apologize for any inconvenience caused.

OBJECTIVE: This study examined cone-beam computed tomography (CBCT)-derived multiplanar-reconstructed (MPR) cross-sections to clarify the salient characteristics of patients with skeletal class III malocclusion with midface deficiency (MD). METHODS: The horizontal and sagittal plane intersection points were identified for middle-third facial analysis in 40 patients in the MD or normal (N) groups. MPR images acquired parallel to each horizontal plane were used for length and angular measurements. RESULTS: A comparison of the MD and N groups revealed significant differences in the zygoma prominence among female patients. The convex zygomatic area in the N group was larger than that in the MD group, and the inferior part of the midface in the N group was smaller than that in the MD group for both male and female patients. A significant difference was observed in the concave middle maxillary area among male patients. CONCLUSIONS: This study was conducted to demonstrate the difference between MD and normal face through MPR images derived from CBCT. Male patients in the MD group had a more flattened face than did those in the N group. Female patients in the MD group showed a concave-shaped lower section of the zygoma, which tended to have more severe MD. These findings indicate that orthognathic surgery to improve skeletal discrepancy requires different approaches in male and female patients.
Cone-Beam Computed Tomography* ; Female ; Humans ; Male ; Malocclusion* ; Orthognathic Surgery ; Zygoma

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.
Adenomyosis ; Cervical Intraepithelial Neoplasia ; Colpotomy ; Endometriosis ; Female ; Fistula ; Humans ; Hysterectomy* ; Ileus ; Leiomyoma ; Length of Stay ; Sutures ; Thrombophlebitis ; Ureter ; Urinary Bladder

Stroke is a leading cause of adult disability and the second-leading cause of death in Korea. It is also the third-leading cause of death in the United States, leading to a serious demand for new interventions to improve the quality of life in stroke survivors. To this end, direct cortical stimulation using an epidural electrode has been reported with promising results in animal and human studies, showing the potential for enhancing the recovery in chronic stroke patients. For optimal results, doctors must be able to modify the stimulation pattern as frequently as needed over a period of time for a given patient. However, severe aftereffects caused by stroke limit patients' activities, making regular doctor visits for treatment difficult. This study aims to develop a prototype of a telemedicine system to enhance stroke recovery by using a ZigBee-based wireless neuro-stimulator. The ZigBee is a stable platform for many low-power wireless applications. To allow stroke patients to remotely obtain neuro-stimulation treatments from their doctors, we connected the ZigBee to the internet. The system also allows doctors to personalize treatment based on the history of the stimulation parameters. The system developed here can also be beneficial as a common platform for a wide range of brain diseases and clinical care for which electric stimulation is used.
Adult ; Animals ; Brain Diseases ; Cause of Death ; Electric Stimulation ; Electrodes ; Humans ; Internet ; Korea ; Quality of Life ; Stroke ; Survivors ; Telemedicine ; United States

BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.
Absorption* ; Area Under Curve ; Body Weight ; Creatinine ; Cyclosporine* ; Drug Monitoring* ; Female ; Humans ; Kidney Transplantation ; Transplantation*

The objective of this study is to evaluate short-term results of total laparoscopic hysterectomy with those of total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy in a retrospective study. We compared patient's age, mean uterine weight, total operating time, length of hospital stay and perioperative hemoglobin concentration change between total laparoscopic hysterectomy (300 patients) and total abdominal hysterectomy (100 patients) and laparoscopically assisted vaginal hysterectomy (52 patients). There were no differences in terms of patient's age, parity between the three groups. There were 7 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 9 minor complications in the abdominal hysterectomy group and 14 minor complications in the total laparoscopic hysterectomy group (P not significant). The length of hospital stay was significantly shorter for total laparoscopic hysterectomy than laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy (p<.001). This study demonstrates that laparoscopic-assisted vaginal hysterectomy and total laparoscopic hysterectomy appears to be as safe as laparotomy and may replace abdominal hysterectomy in most patients and generally has the advantage of shorter hospital stay and earlier return to normal activities.
Female ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Laparotomy ; Length of Stay ; Parity ; Retrospective Studies

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.