Based on the newly-developed engineering technologies, many kinds of useful equipment have been available for minimally invasive surgery. Recently the time to connect clinical needs and advanced technologies has become faster. In this article, we have summarized the recent technologies for endoscopic surgeries. Shadow optic technologies for better geometric perception using dual illumination in a conventional 2-D monitor and "Overview optics" for a panoramic view with an additional visual system are introduced. Micromachine technology is very close to practical implementation for minimally invasive surgeries. Virtual Biopsy is the one of the hottest topics for the next generation of endoscopy. Stereoscopic and volumetric vision systems are still on the way, which should overcome the irritating goggles and stereo display devices. As well as operational theater that integrates all the required equipment with a computer-based system, including voice recognition, still requires the standard protocols to connect many kinds of devices from different manufacturers.
Biopsy ; Endoscopes* ; Human

We developed the system that enables patients to be treated at home during their daily life through digital telemetry and public communication line. In this study, video conference based remote examination and wireless telemetry were integrated together to form a remote monitoring homecare system, and underwent the validation. Test ECG signals were transmitted wirelessly unhindering the person's movement in one floor of our building, and the stability was assessed. The signal were transmitted to remote host via ISDN, with the patient's voice and moving image. To control the system and manage files remotely, the interactive model was devised for this study.
Electrocardiography ; Humans ; Telemetry* ; Voice

OBJECTIVE: To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. RESULTS: The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. CONCLUSION: Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.
Adult ; Aged ; Catheters ; *Cerebrospinal Fluid ; Contrast Media ; Drainage/*methods ; Female ; Fluoroscopy/methods ; Humans ; Lumbosacral Region/*radiography/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Puncture/*methods ; Surgery, Computer-Assisted/methods

BACKGROUND: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. MATERIAL AND METHOD: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4+/-15.91 years (range: 17~76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. RESULT: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6+/-0.81 (range: 1~4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. CONCLUSION: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.
Cartilage ; Female ; Hematoma ; Humans ; Male ; Rib Fractures ; Ribs ; Sternum ; Thoracic Wall ; Thorax ; Transducers

OBJECTIVE: The heartbeat classification of the electrocardiogram is important in cardiac disease diagnosis. For detecting QRS complex, conventional detection algorithmhave been designed to detect P, QRS, Twave, first. However, the detection of the P and T wave is difficult because their amplitudes are relatively low, and occasionally they are included in noise. Furthermore the conventionalmulticlass classificationmethodmay have skewed results to themajority class, because of unbalanced data distribution. METHODS: The Hermite model of the higher order statistics is good characterization methods for recognizing morphological QRS complex. We applied three morphological feature extraction methods for detecting QRS complex: higher-order statistics, Hermite basis functions andHermitemodel of the higher order statistics.Hierarchical scheme tackle the unbalanced data distribution problem. We also employed a hierarchical classification method using support vector machines. RESULTS:We compared classification methods with feature extraction methods. As a result, our mean values of sensitivity for hierarchical classification method (75.47%, 76.16% and 81.21%) give better performance than the conventionalmulticlass classificationmethod (46.16%). In addition, theHermitemodel of the higher order statistics gave the best results compared to the higher order statistics and the Hermite basis functions in the hierarchical classification method. CONCLUSION: This research suggests that the Hermite model of the higher order statistics is feasible for heartbeat feature extraction. The hierarchical classification is also feasible for heartbeat classification tasks that have the unbalanced data distribution.
Classification* ; Diagnosis ; Electrocardiography* ; Heart Diseases ; Noise ; Support Vector Machine

BACKGROUND: There are few tools to detect the diabetic autonomic neuropathy at an earlier stage. This study was conducted to investigate the association between symptoms of autonomic neuropathy and the heart rate variability (HRV) in diabetics. METHODS: Study subjects consisted of 50 diabetic patients and 30 outpatient hospital control patients at a university family medicine department. The patients completed a Korean version of composite autonomic symptom scale (COMPASS). Electrocardiography was recorded in the supine position, on standing, and during deep breathing, for 5 minutes each. HRV of frequency domain was calculated by power spectral analysis. RESULTS: The COMPASS score was higher in female diabetic patients compared with that in controls. Among 50 diabetic patients, the total COMPASS score correlated positively with normalized low frequency (LF) score (normalized units, n.u.) (r = 0.62, P < 0 .001) and low frequency/high frequency (LF/HF) (r = 0.77, P < 0.001), negatively with normalized HF score (n.u.) (r = -0.59, P < 0.001) and RMSSD (square root of the mean of the sum of the square of differences between adjacent NN interval; r = -0.33, P = 0.031). The decrease in LF (n.u) and the increase in HF (n.u) by deep breathing from the supine position were higher in diabetic patients compared with those in controls. The increase in LF (n.u) and the decrease in HF (n.u) by standing from the supine position were lower in diabetic patients compared with those in controls. CONCLUSION: The COMPASS score correlated with some component score of the HRV in diabetics. The HRV may be used as a tool to detect diabetic autonomic neuropathy by augmentation with position change.
Diabetic Neuropathies ; Electrocardiography ; Female ; Heart ; Heart Rate ; Humans ; Outpatients ; Respiration ; Supine Position

Granular cell tumors are uncommon soft tissue neoplasm of nerve sheath origin, which are predominately benign. Granular cells can be found at any site in the body including the tongue, skin, subcutaneous tissue, breast, gastrointestinal, and urogenital systems. However, granular cell tumors have only been rarely described in the chest wall. Here we report a case of a granular cell tumor that occurred in the chest wall of a 59-year-old woman, along with a review of the literature.
Breast ; Female ; Granular Cell Tumor ; Humans ; Middle Aged ; Skin ; Soft Tissue Neoplasms ; Subcutaneous Tissue ; Thoracic Wall ; Thorax ; Tongue ; Urogenital System

BACKGROUND: Restrictive left ventricular (LV) filling patterns after acute myocardial infarction (AMI) predict poor prognosis. Doppler indexes of LV inflow, especially peak velocity ratio of early versus late diastolic flow (E/A) and deceleration time, can predict heart failure or death. Doppler indexes of pulmonary venous flow are also used to diagnose restrictive LV filling, but their prognostic values after AMI are not known. METHODS: Doppler echocardiographic examination were performed in patients with AMI (n=122) between 7 to 10 days after attack, and followed for 30 months. Death group included 9 deaths (7.4%) during follow-up. 18 age-matched patients (control group) were selected from 70 patients without death, heart failure or readmission. Doppler echocardiographic indexes of peak systolic velocity (SV), peak diastolic velocity (DV), and peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow were measured by transthoracic echocardiography. RESULTS: Death group had lower SV (46.1+/-6.3 vs 57.0+/-14.7 cm/sec; p=0.059) and SV/DV ratio (1.26+/-0.50 vs 1.58+/-0.37; p=0.076). Death group had significantly more patients with SV/DV ratio less than 1.3 (67% vs 17%; p=0.026). AR was significantly different between death and control groups (29.7+/-7.8 vs 24.7+/-6.8 cm/sec; p=0.023). Death group had significantly more patients with AR greater than 25 (78% vs 33%; p=0.046). CONCLUSION: SV/DV ratio and AR of pulmonary venous flow predicted death after AMI.
Deceleration ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction* ; Prognosis

An aneurysm is a focal, localized dilatation of a blood vessel. This term is most commonly applied to dilatation of arteries. However, dilatation can occur in any part of the vascular system. Primary true aneurysm of the superficial venous system that contains all the vascular layers is known to be very rare. We report here on surgically treating a case of primary true aneurysm on the dorsalis pedis vein and we briefly review the related literature.
Aneurysm ; Arteries ; Blood Vessels ; Dilatation ; Glycosaminoglycans ; Veins

Purpose: This study aimed to determine the effectiveness and safety of a newly developed endovenous radiofrequency (RF) catheter compared with that of the existing RF catheter in a canine model. Methods: Seven dogs underwent ablation using 1 control catheter (ClosureFAST, CF; Covidien) and 1 experimental catheter (VENISTAR, VS; STARmed Co., Ltd.) in the femoral and cephalic veins. The ablated vein was evaluated macroscopically (2,3,5-triphenyltetrazolium chloride staining, TTC), microscopically (hematoxylin and eosin staining), and ultrasonographically. Vessel injury score was used to evaluate the ablating effect objectively. Veins from 1 dog were evaluated on the day of ablation, while in the remaining 6 dogs, the ablated veins were evaluated 2 weeks later. Results: A total of 23 veins (CF, 11 veins; VS, 12 veins) were ablated in 7 dogs. Non–TTC-stained vein wall areas were identified in all ablated veins. No significant difference was observed in the mean vessel injury score (2.54 ± 1.16 vs. 2.42 ± 1.13, P = 0.656) and the mean vessel wall thickness (0.32 ± 0.03 mm vs. 0.31 ± 0.05 mm, P = 0.212) between CF and VS. There was no blood flow in all veins ablated with VS, whereas there was remaining blood flow in 1 vein ablated with CF. Perivenous complication was not observed. Conclusion Endovenous RF ablation using a newly developed VS RF catheter seems to provide comparable occlusion rate and degree of vein wall injury without perivenous adverse events compared to the most commonly used RF catheter (CF).