Gallstone is a common disease with a prevalence of about 10%, but biliary ileus is a rare entity with a frequency of about 1% for all the symptomatic patients. We are reporting on a case of perforated terminal ileum that was due to gallstone, and this was without any associated intestinal obstruction or bilioenteric fistula. A 76 year old man presented with a history of jaundice and dark colored urine for a 3-month duration with no clinical features of intestinal obstruction. There was no past history of biliary tract disease. The abdominal radiograph demonstrated no biliary stones or classical findings of gallstone ileus, but there was a suspicion of cholangiocarcinoma. Laparotomy was performed. A perforation of terminal ileum was identified in the mesenteric border of the terminal ileum and adjacent to ileocecal valve, and it was wrapped by omentum. A small 1.5 cm sized stone was impacted in the mesentery at the site of the perforation. The perforation site was closed. Cholecystectomy and proximal common bile duct resection with Roux-en-Y choledochojejunostomy was then performed.
Aged ; Biliary Tract Diseases ; Cholangiocarcinoma ; Cholecystectomy ; Choledochostomy ; Common Bile Duct ; Fistula ; Gallstones* ; Humans ; Ileocecal Valve ; Ileum* ; Ileus ; Intestinal Obstruction ; Jaundice ; Laparotomy ; Mesentery ; Omentum ; Prevalence

Background: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures. Methods: A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods. Results: The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA. Conclusions Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

Background: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures. Methods: A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods. Results: The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA. Conclusions Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

Background: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures. Methods: A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods. Results: The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA. Conclusions Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

Background: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures. Methods: A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods. Results: The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA. Conclusions Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

Background: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis (AA) treatment in Korea, a country that did not implement lockdown measures. Methods: A retrospective analysis was conducted during two discretionary time periods: a pre COVID-19 period, and a COVID-19 period. This study included adult and pediatric patients diagnosed with AA who underwent surgical treatment. Clinical and laboratory parameters, changes in surgery timing, disease severity, and postoperative outcomes were compared between the pre and post pandemic periods. Results: The study included a total of 221 patients, with 139 receiving appendectomy in the COVID-19 cohort and 82 in the control cohort. In patients without fever, operative time was significantly longer during the COVID-19 period (p<0.01). Among patients presenting with fever, the rate of complicated AA was higher during the COVID-19 period than in the control period (p<0.01). During the COVID-19 period, the diagnostic and preoperative delay times, as well as postoperative hospital stays, were longer (p<0.05), and the incidence of postoperative complications and other hospital diagnoses was higher (p<0.01) during the COVID-19 period than in the control period. Multivariate analysis showed that age (p=0.03) and the presence of fever (p<0.01) were independent risk factors for complicated AA. Conclusions Older patients and those with fever were at greater risk of severe AA. During outbreaks of infectious diseases like COVID-19, careful consideration is needed regarding surgical interventions in older patients with fever. Understanding vulnerabilities is crucial for disease management in the future.

PURPOSE: Recently, laparoscopic appendectomy (LA) has been widely performed in developed countries. In addition, minimally invasive surgery such as LA is a challenge to surgical residents. The aim of this study is to evaluate learning curve of residents in comparison to that of experienced surgeons. METHODS: Fifty cases of LA that were performed by experienced surgeons (group A) and forty-seven cases of LA that were performed by 8 residents (group B) were reviewed retrospectively. RESULTS: Operative time was longer in group B (50.8+/-12 vs. 82.8+/-40 min. P<0.001). Hospital days of group B was shorter (4.8+/-2.4 vs. 3.7+/-2.1 days P=0.021). No other parameters were statistically significant. In group A, wound infection developed in 1 case. In group B, wound infection developed in 4 cases, intraabdominal abscess in 1, subcutaneous emphysema in 1. CONCLUSION: Inexperienced surgeons can perform laparoscopic appendectomy easily in the early days of individual laparoscopic training course.
Abscess ; Appendectomy ; Developed Countries ; Learning Curve ; Operative Time ; Retrospective Studies ; Subcutaneous Emphysema ; Wound Infection

PURPOSE: Despite the reduced incidence and mortality of gastric cancer, this illness still remains the second leading cause of cancer death in Korea. Various adjuvant chemotherapies have been proposed for patients with advanced gastric cancer. Randomized trials comparing chemotherapies with best supportive care have consistently shown that cytotoxic treatment is of some benefit. Nevertheless, there has been no major improvement in the overall prognosis of advanced gastric cancer. METHODS: We have examined the chemotherapy sensitivity of advanced gastric cancer specimens by using an ex vivo ATP based chemosensitivity assay (ATP-TCA). A variety of chemotherapeutic agents were tested. The one hundred and forty specimens we tested were from resection specimens. RESULTS: The histological tumor classification, lymphatic invasion, neural invasion and venous invasion affected the chemosensitivity of some drugs. 5-FU was a more potent drug than cisplatin, doxorubicin, iriontecan and methotrexate. The chemosensitivity of differentiated cancer was different compared to that of undifferentiated cancer. Doxorubicin and iriontecan were more effective in poorly differentiated, signet ring cell and diffuse type cancers. The manner of tumor invasion affected the chemosensitivity to some drugs. CONCLUSISON: Further study is necessary to assess the effectiveness of some chemotherapy drugs on advanced gastric cancer, including their effect on tumor recurrence and patient survival.
Adenosine Triphosphate ; Cisplatin ; Doxorubicin ; Fluorouracil ; Humans ; Incidence ; Korea ; Methotrexate ; Prognosis ; Recurrence ; Stomach Neoplasms

Vocal cord dysfunction (VCD), a condition that frequently mimics or confounds asthma, is characterized by a paradoxical adduction of the vocal cords on inspiration. The apposition of the vocal cords produces airflow obstruction sufficient to cause wheezing, chest tightness, shortness of breath, and cough. Misdiagnosis as asthma has led to inappropriate treatment, most notably with high-dose corticosteroids. Herein we report two cases of VCD who presented with chronic cough and episodic breathlessness, respectively. Flow-volume loops on spirometry were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as flat or truncated inspiratory loops. Laryngoscopy or bronchoscopy demonstrated paradoxical adduction with posterior "chinking" of the vocal cords on inspiration. One case also had asthma and depressive illness. After the diagnosis of VCD, the clinical manifestations resolved with speech therapy and/or psychotherapy. VCD should be suspected in patients with asthma-like symptoms. An early diagnosis avoids unnecessary aggressive management.
Adrenal Cortex Hormones ; Airway Obstruction ; Asthma ; Bronchoscopy ; Cough ; Diagnosis ; Diagnostic Errors ; Dyspnea ; Early Diagnosis ; Humans ; Laryngoscopy ; Psychotherapy ; Respiratory Sounds ; Speech Therapy ; Spirometry ; Thorax ; Vocal Cord Dysfunction* ; Vocal Cords*

BACKGROUND: Several investigators have demonstrated a considerable disagreement between FEV1 and PEFR to assess the severity of airflow obstruction. The purpose of this study was to examine whether the discrepancy between the two measurements affects the assessment in the severity of acute asthma. METHODS: Thirty-five consecutive asthma patients measured both FEV1 and PEFR at 0, 1hr, 1, 3, 5, 7 days of an emergency room admission using a spirometer and a Ferraris PEFR meter. The degree of discrepancy between FEV1 and PEFR expressed as % predicted values was determined. RESULTS: When predictive equations that recommended by the instrument manufacturers were used, PEFR measured with the PEFR meter (f-PEFR) was significantly higher than FEV1 at all time points, with 16.1% mean difference and unacceptable wide limits of agreement (-20.0~52.3%). The classification in severity was significantly different between FEV1 and f-PEFR (p < 0.001). The discrepancy was inter-instrumental in large part because f-PEFR was 10.1% higher than spirometric PEFR. Different predictive equations altered the degree of the differences but could not completely correct it. CONCLUSION: These results indicate that f-PEFR values underestimate the severity of airflow obstruction in acute asthma despite using recommended predictive equations. Therefore, these confounding factors should be considered when the severity of airflow obstruction is assessed with PEFR.
Acute Disease ; Adult ; Aged ; Airway Obstruction/diagnosis/*physiopathology ; Asthma/*physiopathology ; Comparative Study ; Female ; Forced Expiratory Volume/physiology ; Human ; Male ; Middle Age ; Peak Expiratory Flow Rate/*physiology ; Predictive Value of Tests