PURPOSE: The impressive effect of LRYGBP on mildly obese patients (30 kg/m2 < BMI < 35 kg/m2) with T2DM raises the argument for lowering the threshold for surgical intervention to non-obesity (BMI < 30 kg/m2). The goal of this study was to evaluate the effect of gastrectomy on non-obese patients with T2DM and what preoperative clinical factors are associated with postoperative long term improvement. METHODS: In this retrospective review, we analyzed the change in diabetic status in 75 patients with gastric cancer undergoing three different gastrectomies in a single institution from June 1996 to September 2009. Pre- and postoperative fasting blood glucose, serum hemoglobin A1c and diabetic medication requirements were compared. The demographic data and other biochemical markers were also collected. RESULTS: At an average follow-up of 35.0 +/- 25.9 months, we collected the data of 75 patients and evaluated the change of diabetes status. There was no resolution of diabetes in Billroth-I (B-I) group, and 45.2% of patients improved whereas the resolution rate of Billroth-II (B-II) and RY group was 22.2% and 23.5% and 85.2% and 88.2%, respectively. The improvement rate of diabetes mellitus (DM) status was 7.46 times higher in B-II than in B-I patients. The method of reconstruction is the most powerful factor and severity and duration of diabetes showed significant clinical factors for the improvement of the disease after surgery. CONCLUSION: According to these results, foregut-bypass procedure may improve the type 2 DM better than can be explained by the effect of weight loss only. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years.
Biomarkers ; Blood Glucose ; Body Mass Index ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hemoglobins ; Humans ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Weight Loss

Background: The largest outbreak of enterohemorrhagic Escherichia coli (EHEC) O157:H7 occurred at a preschool in South Korea from June 12 to 29, 2020. This study aimed to analyze the epidemiological and clinical characteristics of EHEC infection in this outbreak. Methods: Epidemiological investigation was performed on all 184 children and 19 workers at the preschool using a standard questionnaire to assess symptoms, food intake, attendance, and special activity history. Pulsed-field gel electrophoresis analysis of confirmed cases was performed to determine genetic relevance. Results: During this outbreak, 103 children were affected, whereas only one infection was identified in adults. Of the 103 pediatric patients, 85 had symptoms (82.5%), including diarrhea, abdominal pain, bloody stool, fever, and vomiting. Thirty-two patients (31.1%) were hospitalized, 15 (14.6%) were diagnosed with hemolytic uremic syndrome, and 4 (3.9%) received dialysis treatment. Pulsed-field gel electrophoresis analysis identified 4 genotypes with high genetic relevance (92.3%). Epidemiological investigation revealed that this outbreak might have occurred from ingesting foods stored in a refrigerator with a constant temperature above 10°C, which was conducive to bacterial growth. Despite several measures after outbreak recognition, new infections continued to appear. Therefore, the preschool was forced to close on June 19 to prevent further person-to-person transmission. Conclusion Our findings from the response to the largest outbreak will help prepare countermeasures against future EHEC outbreak.

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngophanmgoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.
Adult ; Eating* ; Endoscopy ; Esophageal Perforation ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Jeollanam-do ; Meat ; Mediastinitis ; Mortality ; Mouth ; Numismatics ; Oropharynx ; Pneumonia, Aspiration ; Stomach ; Surgical Instruments

PURPOSE: Some patients who undergo surgical resection of pancreatic cancer survive longer than other patients. The purpose of this study was to identify the factors that affect long-term survival after resection of histopathologically confirmed pancreatic ductal adenocarcinoma. METHODS: A single-center, retrospective study was conducted among 164 patients who underwent surgical resection of pancreatic cancer, between May 1995 and December 2004. The patient follow-up process was conducted via telephone survey and review of electronic medical records for at least 5 years or until death. RESULTS: We compared patients with long-term (> or =60 months, n = 19) and short-term survival (<60 months, n = 145). Resection margin status, differentiation of the tumor, tumor stage, pre-operative serum level of albumin, total bilirubin and carbohydrate antigen (CA) 19-9 level are related with survival difference (all factors, P < 0.05). Multivariate analysis revealed that a pre-operative serum total bilirubin level <7 mg/dL and a pre-operative serum CA19-9 level <37 U/mL is a statistically significant prognostic factor for long-term survival. CONCLUSION: The preoperative serum total bilirubin and serum CA19-9 levels are associated with long-term survival after surgical resection of pancreatic cancer.
Adenocarcinoma ; Bilirubin ; Electronic Health Records ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Pancreatic Ducts ; Pancreatic Neoplasms ; Retrospective Studies ; Telephone

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

PURPOSE: Pressure sore wound develops inevitably in long-term, immobilized and hospitalized patients. Sore wound infection is common problem and makes healing process difficult. We aimed to identify the pathogens of the purulent discharge in sore wound and to obtain information for appropriate antibiotics through a sensitivity test METHODS: The bacteriologic study was made on 120 cases of patients who admitted or visited our hospital from 2004 January to 2005 December for sore wound treatment. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK and Microscan was used for sensitivity test. RESULTS: Among 120 specimens, organisms were isolated from 77(64.2%) cases. Gram positive organisms were cultured in 73 specimens, Gram negative organisms in 46 specemens, and fungi in 2 specimens. Mixed infection by Gram (+) and Gram (-) bacteria were observed in 34 specimens. Among them, S. aureus was the most common isolate in 24(31.2%) patients and 10 (13.0%) S. Aureus isolates were MRSA. The most prevalent Gram-negative organism was Escherichia coli in 20 patients(25.9%). Vancomycin and teicoplanin showed highest sensitivity to Gram-positive organisms and imipenem and amikacin to Gram-negative organisms. CONCLUSION: Pressure sore wound demands consideration of multimodal therapeutic aspects and these findings would be useful informations to physicians, nurses and clinical assistants in understanding the nature of sore wound and selecting appropriate antibiotics.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Bacteria ; Bacteriology* ; Coinfection ; Escherichia coli ; Fungi ; Humans ; Imipenem ; Methicillin-Resistant Staphylococcus aureus ; Pressure Ulcer* ; Teicoplanin ; Vancomycin ; Wound Infection ; Wounds and Injuries

The benefits of bilateral cochlear implants (CIs) include better understanding of speech in noise and localization of sound sources. Following the improvement observed in adults, children were also included in the bilateral CIs program. The aim of this study was to investigate the impact of bilateral CIs use on speech perception in quiet and in noise. Four children underwent testing from 9 to 18 months after activation of bilateral hearing. Speech perception tests in quiet and in noise (signal to noise ratio of +10 dB) were performed in all children with the first CI alone and bilaterally. Subjects showed varying degrees of improved performance on speech perception tests in quiet and in noise according to bilateral auditory experience. Bilateral CIs can offer a substantial benefit in speech perception in quiet and in noise. The extent of the advantage, however, may require a more prolonged period of adjustment and learning.
Adult ; Child* ; Cochlear Implantation* ; Cochlear Implants* ; Hearing ; Humans ; Learning ; Noise ; Speech Perception

Vascular neoplasms are the most common non-epithelial tumors in the nasal and paranasal regions. However, heman-giopericytomas usually occur in the retroperitoneum or in the thigh and are uncommon in the nasal cavity and paranasal sinuses. Nasal hemangiopericytoma-like (HPCL) tumors should be differentiated from typical hemangiopericytomas. HPCL tumors, a distinctive variety of vascular neoplasm, often originate in a paranasal sinus and extend into the nasal cavity secondarily. They occur most commonly in adults in the sixth and seventh decades of life and clinically mimic allergic polyps with symptoms of nasal obstruction and epistaxis. Microscopically, HPCL tumors are composed predominantly of spindle cells and lack nuclear or cytoplasmic pleomorphism, mitotic activity, hemorrhage, or necrosis demonstrating a vascular architecture. We report a rare case of HPCL tumor originating from nasal septum in a 45-year-old man with the following immunohistochemical features: vimentin (+), CD34 (+), S-100 protein (-), desmin (-), factor VIII-related antigen (-), and fuchinophilia on Masson trichrome stain.
Adult ; Cytoplasm ; Desmin ; Epistaxis ; Hemangiopericytoma ; Hemorrhage ; Humans ; Immunohistochemistry ; Middle Aged ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum* ; Necrosis ; Paranasal Sinuses ; Polyps ; S100 Proteins ; Thigh ; Vascular Neoplasms ; Vimentin ; von Willebrand Factor

BACKGROUND/AIMS: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10~20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. METHODS: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. RESULTS: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2 : 1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. CONCLUSIONS: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required
Alligators and Crocodiles ; Animals ; Chungcheongnam-do ; Deglutition ; Diabetes Mellitus ; Eating ; Endoscopy ; Esophageal Diseases ; Esophagus ; Female ; Foreign Bodies* ; Hand Strength ; Humans ; Hypertension ; Male ; Numismatics ; Stomach Neoplasms ; Surgical Instruments ; Tooth ; Upper Gastrointestinal Tract*

Objective: The Montreal Cognitive Assessment (MoCA) is recommended for general cognitive evaluation in Parkinson’s disease (PD) patients. However, age- and education-adjusted cutoffs specifically for PD have not been developed or systematically validated across PD cohorts with diverse education levels. Methods: In this retrospective analysis, we utilized data from 1,293 Korean patients with PD whose cognitive diagnoses were determined through comprehensive neuropsychological assessments. Age- and education-adjusted cutoffs were formulated based on 1,202 patients with PD. To identify the optimal machine learning model, clinical parameters and MoCA domain scores from 416 patients with PD were used. Comparative analyses between machine learning methods and different cutoff criteria were conducted on an additional 91 consecutive patients with PD. Results: The cutoffs for cognitive impairment decrease with increasing age within the same education level. Similarly, lower education levels within the same age group correspond to lower cutoffs. For individuals aged 60–80 years, cutoffs were set as follows: 25 or 24 years for those with more than 12 years of education, 23 or 22 years for 10–12 years, and 21 or 20 years for 7–9 years. Comparisons between age- and education-adjusted cutoffs and the machine learning method showed comparable accuracies. The cutoff method resulted in a higher sensitivity (0.8627), whereas machine learning yielded higher specificity (0.8250). Conclusion Both the age- and education-adjusted cutoff methods and machine learning methods demonstrated high effectiveness in detecting cognitive impairment in PD patients. This study highlights the necessity of tailored cutoffs and suggests the potential of machine learning to improve cognitive assessment in PD patients.