PURPOSE: Laparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA). METHODS: We retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA. RESULTS: A total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients. CONCLUSION: LSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Gallbladder ; Hemorrhage ; Hospitalization ; Humans ; Laparotomy ; Liver ; Medical Records ; Mortality ; Retrospective Studies ; Surgeons

OBJECTIVE: To examine the relation between the presence of penetration or aspiration and the occurrence of the clinical indicators of dysphagia. The presence of penetration or aspiration is closely related to the clinical indicators of dysphagia. It is essential to understand these relationships in order to implement proper diagnosis and treatment of dysphagia. METHODS: Fifty-eight poststroke survivors were divided into two groups: patients with or without penetration or aspiration. Medical records and videofluoroscopic swallowing examinations were reviewed. The occurrence of clinical indicators of dysphagia between two groups was analyzed with Cross Tabulation and the Pearson chi-square test (p<0.05). RESULTS: Poststroke survivors with penetration or aspiration had significantly high occurrences of delayed initiation of the swallow (p=0.04) and reduced hyolaryngeal elevation (p<0.01) than those without penetration or aspiration. CONCLUSION: The results of this study indicate that delayed initiation of the swallow is a strong physiological indicator of penetration or aspiration during the oral stage of swallowing in poststroke survivors. For the pharyngeal stage of swallowing, hyoid and laryngeal elevation is a key event related to occurrence of penetration or aspiration. Clinical indicators should be investigated further to allow appropriate implementation of treatment strategies for stroke survivors.
Deglutition ; Deglutition Disorders* ; Diagnosis ; Humans ; Medical Records ; Oral Stage ; Stroke ; Survivors*

A 25-year-old man developed tracheal stenosis due to prolonged intubation for five days. Immediately after bougienage, his left lung was not possible to ventilate and emergency tracheostomy was performed to produce ample space for airflow. Fiberoptic bronchoscopy showed that his left main bronchus was totally obstructed by sputum at the entrance of the superior and inferior lobar bronchi. Inadequate airway clearance increases the risk of infection and airway obstruction. We suggest chest physiotherapy be applied to all patients in the intensive care unit (ICU), especially patients with tracheal stenosis, due to its positive impact on pulmonary functional ability and ICU stay.
Adult ; Airway Obstruction ; Bronchi ; Bronchoscopy ; Emergencies ; Humans ; Intensive Care Units ; Intubation ; Lung ; Sputum* ; Thorax ; Tracheal Stenosis ; Tracheostomy

We conducted this study to examine the effects of safflower seed granular tea containing physiologically active polyphenols on antioxidative activities and bone metabolism. Forty postmenopausal women ages 49 to 64-years were recruited from Daegu and Gyeongbuk and were randomly assigned to either a safflower tea supplement (Saf-tea) group (n = 27) or a placebo group (n = 13). The Saf-tea group received 20 g of safflower seed granule tea per day containing a 13% ethanol extract of defatted safflower seeds, whereas the placebo group received a similar type of tea that lacked the ethanol extract. No significant changes in nutrient intake for either the placebo or Saf-tea groups were observed before or after the study period, except vitamin A intake increased after 6 months in the Saf-tea group. Dietary phytoestrogen intakes were similar in the Saf-tea group (60.3 mg) and placebo group (52.5 mg). Significant increases in plasma genistein and enterolactone were observed in the Saf-tea group. After 6 months of supplementation, serum levels of antioxidant vitamins such as alpha-tocopherol and ascorbic acid increased significantly, and TBARS levels decreased in the Saf-tea group compared to the placebo group. Serum osteocalcin levels were reduced (P < 0.05) in the Saf-tea group after 6 months, whereas serum osteocalcin did not change in the placebo group. Urinary deoxypyridinoline/creatinine excretion was not different between the two groups at baseline, and did not change in either group after 6 months. Bone mineral density decreased significantly in the placebo group (P < 0.01) but not in the supplemented group. It was concluded that polyphenols (72 mg/day), including serotonin derivatives, in the Saf-tea had both antioxidant and potential bone protecting effects in postmenopausal women without liver toxicity.
4-Butyrolactone ; alpha-Tocopherol ; Ascorbic Acid ; Bone Density ; Carthamus tinctorius ; Ethanol ; Female ; Genistein ; Humans ; Lignans ; Liver ; Osteocalcin ; Phytoestrogens ; Plasma ; Polyphenols ; Seeds ; Serotonin ; Tea ; Thiobarbituric Acid Reactive Substances ; Vitamin A ; Vitamins

OBJECTIVES: Gestational diabetes mellitus (GDM) affects 2%-4% of the all pregnant women, and it is a major risk factor for development of type 2 DM. We performed this cross-sectional study to determine whether there were defects in insulin secretory capacity or insulin sensitivity in women with previous GDM. METHODS: On 6-8 weeks after delivery, 75 g oral glucose tolerance test was performed in 36 women with previous GDM and 19 non-pregnant control women matched with age and weight. Intravenous glucose tolerance test was performed on 10-14 weeks after delivery. Insulin secretory capacity measured as the acute insulin response to glucose (AIRg) and insulin sensitivity as minimal model derived sensitivity index (S(I)) were obtained. AIRg x S(I) (beta-cell disposition index) was used as an index of beta-cell function. RESULTS: Women with previous GDM were classified into normal glucose tolerance (postpartum-NGT, n=19) and impaired glucose tolerance (postpartum-IGT, n=17). Postpartum fasting glucose levels were significantly higher in postpartum-IGT compared to postpartum-NGT and control (P<0.05). AIRg x S(I) was significantly lower in postpartum-IGT compared to control (P<0.05). S(I) was lower in postpartum-NGT and postpartum-IGT compared to control, but the difference did not have the statistical significance. Frequency of parental history of type 2 diabetes was significantly greater in postpartum-IGT compared to postpartum-NGT (P<0.05). CONCLUSION: Women with previous GDM showed impaired insulin secretion although their glucose tolerance states were restored to normal. It suggests impaired early insulin secretion may be a major pathophysiologic factor for development of type 2 DM, and this defect may be genetically determined.
Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; Diabetes, Gestational* ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin Resistance ; Insulin* ; Insulin-Secreting Cells ; Parents ; Postpartum Period ; Pregnancy ; Pregnant Women ; Risk Factors

PURPOSE: Arterial hypotension after return of spontaneous circulation (ROSC) from out of hospital cardiac arrest (OHCA) occurs frequently. However, few studies have described post-ROSC hypotension and the relationship with outcome in OHCA. This study aimed to find the prevalence of post-ROSC hypotension and to determine whether post-ROSC hypotension predicts outcome in OHCA. METHODS: This was a retrospective cohort study of patients with ROSC (>20 minutes) after OHCA and who were admitted to the emergency department in a tertiary hospital from July, 2005 to June, 2009. Patients' baseline characteristics, presence of arterial hypotension (<90 mmHg), mortality, and neurologic outcome were evaluated. Mortality rates were compared and multivariate logistic regression was used to determine if post-ROSC hypotension independently predicted death. RESULTS: One hundred forty seven patients (93 males) were studied. Post-ROSC hypotension occurred in 108(73%) patients and was associated with significantly higher mortality compared to non-exposure (82% vs. 44% p<0.001). In multivariate logistic regression analysis, post-ROSC hypotension (OR 4.4 [95% CI]) and non-cardiogenic causes (OR 19.7 [95% CI]) were independent predictors of death. CONCLUSION: Post-ROSC hypotension is common and can be an independent predictor of death in OHCA.
Cohort Studies ; Emergencies ; Heart Arrest ; Humans ; Hypotension ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Prevalence ; Resuscitation ; Retrospective Studies ; Tertiary Care Centers

Objective: : Chronic subdural hematomas (cSDHs) are generally known to result from traumatic tears of bridging veins. However, the causes of repeat spontaneous cSDHs are still unclear. We investigated the changes in vasculature in the human dura mater and outer membrane (OM) of cSDHs to elucidate the cause of their spontaneous repetition. Methods: : The dura mater was obtained from a normal control participant and a patient with repeat spontaneous cSDHs. The pathological samples from the patient included the dura mater and OM tightly adhered to the inner dura. The samples were analyzed with a particular focus on blood and lymphatic vessels by immunohistochemistry, 3-dimensional imaging using a transparent tissue clearing technique, and electron microscopy. Results: : The dural border cell (DBC) layer of the dura mater and OM were histologically indistinguishable. There were 5.9 times more blood vessels per unit volume of tissue in the DBC layer and OM in the patient than in the normal control. The DBC layer and OM contained pathological sinusoidal capillaries not observed in the normal tissue; these capillaries were connected to the middle meningeal arteries via penetrating arteries. In addition, marked lymphangiogenesis in the periosteal and meningeal layers was observed in the patient with cSDHs. Conclusion : Neovascularization in the OM seemed to originate from the DBC layer; this is a potential cause of repeat spontaneous cSDHs. Embolization of the meningeal arteries to interrupt the blood supply to pathological capillaries via penetrating arteries may be an effective treatment option.