Striae gravidarum are a common problem in postpartum women, who may experience serious emotional distress due to multiple streaks of scars on the abdomen. There is still no consensus on the treatment method for this problem. For a postpartum woman in her late 30s, who requested striae removal from the lower mid-abdomen, we developed and performed the keyhole-shaped vertical mini-abdominoplasty. This 37-year-old woman, who had given birth to two children, presented with multiple striae on the lower mid-abdomen and periumbilical area, as well as mild bulging in this area. The keyhole-shaped vertical mini-abdominoplasty, including multiple striae on the lower mid-abdomen and periumbilical skin, was designed. An area of striated lower abdominal and periumbilical skin, measuring approximately 10×15 cm2 and weighing about 450 g, was excised. Midline reinforcement of the loosened anterior rectus sheath with 3-0 Prolene sutures was done. Both lateral abdominal skin flaps were medially advanced to close the skin defects. Postoperatively, the patient had a favorable lower abdominal appearance with markedly fewer striae on the lower mid-abdomen and periumbilical area. The keyhole vertical mini-abdominoplasty can effectively correct moderate striae on the lower mid-abdomen and periumbilical area in postpartum women in their late 30s to middle age.

The original version of this article contained wrong informations of some authors which should be changed.

BACKGROUND AND PURPOSE: Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. METHODS: We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. RESULTS: In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. CONCLUSIONS: The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.
Cognition ; Demography ; Humans ; Korea ; Movement Disorders* ; Parkinson Disease* ; Prevalence ; Quality of Life*

OBJECTIVE: Little is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors. METHODS: We enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not. RESULTS: After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being. CONCLUSION: The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors.
Comorbidity ; Depression ; Employment ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Quality of Life ; Survivors ; Unemployment ; Uterine Cervical Neoplasms

BACKGROUND: This study was designed to assess the effects of pneumoperitoneal pressure (PP) and positional changes on the respiratory mechanics during laparoscopy assisted colectomy. METHODS: Peak inspiratory pressure, plateau pressure, lung compliance, and airway resistance were recorded in PP of 10 mmHg and 15 mmHg, with the position change in 5 steps: head-down at 20degrees, head-down at 10degrees, neutral position, head-up at 10degrees and head-up at 20degrees. RESULTS: When the patient was placed head-down, the position change accentuated the effects of pneumoperitoneum on respiratory mechanics. However, when the patient was placed in a head-up position during pneumoperitoneum the results showed no pattern. In the 20degrees head-up position with the PP being 10 mmHg, the compliance increased from 30.6 to 32.6 ml/cmH2O compared with neutral position (P = 0.002). However with the PP being 15 mmHg, the compliance had not changed compared with neutral position (P = 0.989). In 20degrees head-down position with the PP of 10 mmHg, the compliance was measured as 24.2 ml/cmH2O. This was higher than that for patients in the 10degrees head-down position with a PP of 15 mmHg, which was recorded as 21.2 ml/cmH2O. Also in the airway resistance, the patient in the 20degrees head-down position with the PP of 10 mmHg showed 15.8 cmH2O/L/sec, while the patient in the 10degrees head-down position with the PP of 15 mmHg showed 16.2 cmH2O/L/sec of airway resistance. These results were not statistically significant but still suggested that the head-down position accentuated the effects of pneumoperitoneum on respiratory mechanics. CONCLUSIONS: Our results suggest that respiratory mechanics are affected by the patient position and the level of PP - the latter having greater effect.
Airway Resistance ; Colectomy ; Compliance ; Humans ; Laparoscopy ; Lung Compliance ; Pneumoperitoneum ; Respiratory Mechanics

BACKGROUND: Optiscope(TM) is a newly developed video stylet device. This study evaluated and compared the hemodynamic changes observed after endotracheal intubation with video stylet and after conventional laryngoscopic endotracheal intubation. METHODS: Fifty-eight adult patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2, undergoing general anesthesia, were randomized into two groups: one group of patients were intubated using video stylet (n = 29) and the other group were intubated using direct laryngoscope (n = 29). Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), heart rate (HR), POGO (percentage of glottic opening) score, time for intubation and degree of sore throat were recorded. RESULTS: There were no significant differences in the SBP, MAP, DBP, HR, and the sore throat incidence between the two groups. Optiscope(TM) produced better POGO scores, but time for intubation was longer than with conventional laryngoscope. CONCLUSIONS: Optiscope(TM), when compared with conventional laryngoscope for intubation, does not modify the hemodynamic response, but it provides a better view of the vocal cords.
Adult ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bronchoscopes ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Pharyngitis ; Video Recording ; Vocal Cords

PURPOSE: Surgery remains the treatment of choice for a hepatocellular carcinoma (HCC) confined within the liver. When there is no underlying liver disease, resection is the preferred option. In cases of HCC with cirrhosis, impaired hepatic reserve often precludes safe resection. Recently, acceptable transplantation outcomes have been shown in selected HCC patients. The aim of this study was to review the results of liver transplantation for HCC at the Asan Medical Center. METHODS: 73 HCC patients were treated by liver transplantation between August 1992 and April 2001. There were 7 in-hospital mortalities. The mean age of the patients was 51 years. The period of the median follow-up was 22 months. By reviewing the patients' medical records, we investigated tumor size, and number, TNM stage, survival rates, and recurrences. Statistical analysis was performed using Statistica 5.1 and SPSS 9.0. RESULTS: Among 67 patients, 8 (12%) developed a tumor recurrence or distant metastasis following the liver transplantation. The 3 year and 5 year survival rate were 88 and 57%, respectively. There were 12 incidentalomas. The 1 year and 3 year disease free survival rates of 54 cases, with the exception of the incidentalomas, were 80 and 50%, respectively. There were no statistically significant differences in the survival rates between the groups, with and without preoperative TACE (P=0.70). Also, there were no statistically significant differences in the survival rates between cadaveric donor liver transplantations (CDLT) and living donor liver transplantations (LDLT). CONCLUSION: We assume that transplantation for HCC, in carefully selected patients, may be the solution to HCC in cirrhotic livers. If the donor safety with a LDLT can be ensured, its application to patients with cirrhosis and early HCC may be a solution to the donor shortage, which could improve the survival of this group of patients.
Cadaver ; Carcinoma, Hepatocellular* ; Chungcheongnam-do ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Hospital Mortality ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Survival Rate ; Tissue Donors

PURPOSE: Although there has been recent progress in surgical techniques, such as perioperative management, immunosuppresive regimen and intervention radiology, a liver retransplantation remains as the only therapeutic option for patients with a failing liver allograft. The purpose of this study was to review our clinical experiences of liver retransplantation, performed at the Asan Medical Center. METHODS: Between August 1992 and March 2001, 400 cases of liver transplantations, including 331 in adults and 69 in pediatrics, were performed. Of the 331 adult cases, 10 cases of liver retransplantation, during the same period, were retrospectively analyzed. RESULTS: In the 331 cases of adult liver transplantation, 232 cases of living donor and 99 of cadaveric liver transplantations were carried out. The 331 adult cases also included 10 liver retransplantations. Therefore, the overall liver retransplantation rate was 3%. Primary non-function (PNF) was the leading cause of retransplantation. The conversion of living donor liver transplantation to a cadaveric liver retransplantation was the most common type of retransplantaion, with a cadaveric to cadaveric type the second most common. The in-hospital mortality was 40%. The causes of in-hospital mortality were hepatic artery pseudoaneurysm rupture, Aspergillus pneumonia, and multiple organ failure, initiated by jejuno-jejunostomy site bleeding and massive hepatic necrosis. CONCLUSION: In the current era of extreme organ shortage, retransplantation is the only therapeutic alternative for irreVersible graft failure, especially if the patient has no multiple organ failure (MOF) prior to the operation. Therefore, the careful selection of patients for a retransplantation is required. They should be given superurgent priority if the circumstances permit, and living donor liver transplantation (LDLT) offer a promising alternative.
Adult ; Allografts ; Aneurysm, False ; Aspergillus ; Cadaver ; Chungcheongnam-do ; Hemorrhage ; Hepatic Artery ; Hospital Mortality ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Massive Hepatic Necrosis ; Multiple Organ Failure ; Pediatrics ; Pneumonia ; Retrospective Studies ; Rupture ; Transplants

PURPOSE: Inhaled nitric oxide (iNO) has been known to improve oxygenation in newborns with persistent pulmonary hypertension (PPHN). This study was performed to evaluate the predictors of clinical outcome in the newborn infants with PPHN treated with iNO. METHODS: Between September 1998 and August 2002, 23 newborn infants with PPHN treated with iNO were enrolled in this study. Reduction of oxygenation index (OI) and AaDO2 to 30% or more were defined as clinical response. Accoding to the response time within or after 12 hours, the clinical response was sub-categorized as early or delayed response, respectively. RESULTS: The mean gestational age and birth weight of 23 newborn infants were 36.7+/-4.4 weeks and 2,644+/-907 g. The mean baseline OI and AaDO2 were 22.20+/-13.63 and 477.16+/-127.96. There were ten non-responsders, eight early responsders and five delayed responders. Eleven neonates showed sustained response for 24 hours. The mean AaDO2, and PaO2 were decreased after 12 hours (P<0.05), while there was no difference in oxygenation index, arteral pH and PaCO2. The mortality rates of non-responders or not- sustained responders were higher than those of responders or sustained responders (P< 0.05). The birth weight of death group was lower than that of survival group and AaDO2, and OI at 12 hours after iNO therapy in survival group were lower than those in death group. CONCLUSION: Predictors of the clinical outcome of iNO therapy were clinical response patterns after iNO therapy, time taken until clinical response, duration of response and change of oxygenation at 12 hours after iNO therapy.
Birth Weight ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Infant, Newborn* ; Mortality ; Nitric Oxide* ; Oxygen ; Reaction Time

PURPOSE: Inhaled nitric oxide (iNO) has been known to improve oxygenation in newborns with persistent pulmonary hypertension (PPHN). This study was performed to evaluate the predictors of clinical outcome in the newborn infants with PPHN treated with iNO. METHODS: Between September 1998 and August 2002, 23 newborn infants with PPHN treated with iNO were enrolled in this study. Reduction of oxygenation index (OI) and AaDO2 to 30% or more were defined as clinical response. Accoding to the response time within or after 12 hours, the clinical response was sub-categorized as early or delayed response, respectively. RESULTS: The mean gestational age and birth weight of 23 newborn infants were 36.7+/-4.4 weeks and 2,644+/-907 g. The mean baseline OI and AaDO2 were 22.20+/-13.63 and 477.16+/-127.96. There were ten non-responsders, eight early responsders and five delayed responders. Eleven neonates showed sustained response for 24 hours. The mean AaDO2, and PaO2 were decreased after 12 hours (P<0.05), while there was no difference in oxygenation index, arteral pH and PaCO2. The mortality rates of non-responders or not- sustained responders were higher than those of responders or sustained responders (P< 0.05). The birth weight of death group was lower than that of survival group and AaDO2, and OI at 12 hours after iNO therapy in survival group were lower than those in death group. CONCLUSION: Predictors of the clinical outcome of iNO therapy were clinical response patterns after iNO therapy, time taken until clinical response, duration of response and change of oxygenation at 12 hours after iNO therapy.
Birth Weight ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Infant, Newborn* ; Mortality ; Nitric Oxide* ; Oxygen ; Reaction Time