The laparoscopic pancreaticoduodenectomy (LPD), introduced by Gagner and Pomp in 1994, is typically done in high-volume centers due to its technical demands. Our methods aim to provide effective traction, enabling efficient surgery despite limited staffing. A retrospective analysis of 29 patients undergoing LPD by a single surgeon between September 2021 and December 2022 showed promising outcomes: median intraoperative bleeding of 425 mL, operation time of 505 minutes, and postoperative hospital stay of 10 days. With only one case requiring open conversion, our external retraction techniques demonstrate efficacy in overcoming challenges associated with manpower constraints, highlighting potential utility for surgeons in similar settings. We share LPD external retraction techniques and outcomes.

Percutaneous transthoracic needle biopsy (PTNB) is one of the essential diagnostic procedures for pulmonary lesions. Its role is increasing in the era of CT screening for lung cancer and precision medicine. The Korean Society of Thoracic Radiology developed the first evidence-based clinical guideline for PTNB in Korea by adapting pre-existing guidelines. The guideline provides 39 recommendations for the following four main domains of 12 key questions: the indications for PTNB, pre-procedural evaluation, procedural technique of PTNB and its accuracy, and management of post-biopsy complications. We hope that these recommendations can improve the diagnostic accuracy and safety of PTNB in clinical practice and promote standardization of the procedure nationwide.

Norovirus is a leading cause of epidemic and sporadic acute gastroenteritis worldwide. Rapid and accurate detection of norovirus is essential for the prevention and control of norovirus outbreaks. The purpose of this study was to propose and develop a process for establishing appropriate standardized guidelines for the approval and evaluation of in vitro diagnostic medical devices (IVDD) for norovirus detection in Korea based on the related laws, regulations, and guidelines of USA, Europe, and Korea. We expect that this study could be used for diagnostic test standardization and the approval and evaluation of domestic norovirus diagnostic devices. We also expect the results will contribute to industrial expansion and public health promotion.
Diagnostic Tests, Routine* ; Disease Outbreaks ; Europe ; Gastroenteritis ; Jurisprudence ; Korea* ; Norovirus* ; Public Health ; Reagent Kits, Diagnostic ; Social Control, Formal

BACKGROUND/AIMS: To evaluate the diagnostic value of contrast (SonoVue(R)) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses. METHODS: CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI. RESULTS: The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with kappa values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a kappa value of 0.765. CONCLUSIONS: If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses.
Adult ; Aged ; Contrast Media/diagnostic use ; Female ; Humans ; Liver Diseases/pathology/radiography/*ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo

PURPOSE: This study was performed to evaluate whether N-terminal pro-brain-type natriuretic peptide (NT-proBNP) could predict 28-day mortality in patients with severe sepsis and septic shock. METHODS: We performed a retrospective analysis of prospectively collected data from patients with severe sepsis and septic shock. Patients' demographic data, comorbidities, blood test results (including NT-proBNP concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and nonsurvivors. NT-proBNP levels were categorized into quartiles by their concentration (< or =600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml). Multivariate Cox proportional hazard regression analysis was performed to identify the predictors of mortality during a 28-day follow-up period. RESULTS: Out of 349 patients, 117(33.5%) died. NT-proBNP concentrations were significantly higher in nonsurvivors compared to survivors (median 4,630 [IQR, 1,876-10,582] vs. 1,552 [IQR, 440-4,064] pg/ml, respectively, p<0.01). The mortality rate increased with increasing NT-proBNP concentrations; patients with NT-proBNP < or =600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml were 12.9%, 26.1%, 39.8%, and 51.1%, respectively. By Cox proportional hazards analysis, compared to patients with the lowest NT-proBNP levels (< or =600 pg/ml), patients in groups with higher NT-proBNP levels were more associated with 28-day mortality; 601 to 2,000 pg/ml (hazard ratio [HR], 1.15; 95% CI, 0.50-2.63); 2,001 to 6,000 pg/ml (HR, 2.10; 95% CI, 1.05-4.81); >600 pg/ml (HR, 2.30; 95% CI, 1.15-6.14). CONCLUSION: NT-proBNP is an independent prognostic factor for 28-day mortality in patients with severe sepsis and septic shock.
APACHE ; Comorbidity ; Follow-Up Studies ; Hematologic Tests ; Humans ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Prospective Studies ; Retrospective Studies ; Sepsis ; Shock, Septic ; Survivors

PURPOSE: To investigate the caspase-3 expression in the acinar and ductal cells of rat submandibular glands after the irradiation of various doses. MATERIALS AND METHODS: The male Sprague-Dawley rats weighing approximately 250 gm were used for this study. The experimental group was irradiated with a single absorbed dose of 2, 5, 10, and 15 Gy on the head and neck region. The rats were sacrificed on the 1st, 3rd, 7th, 14th, 21st, and 28th day after irradiation. The specimens including the submandibular gland were sectioned and observed using histopathological and immunohistochemical methods. RESULTS: The local destruction of the acinar and ductal cells and the karyopyknotic nuclei of the acinar cells were observed in the 2 Gy and 5 Gy irradiation groups later than in the 10 Gy and 15 Gy irradiation groups. And the expression of caspase-3 was prominent only in the ductal cells in the 2 Gy and 5 Gy irradiation groups. CONCLUSION: This experiment suggests that radiation-induced apoptosis in the ductal cells of rat submandibular glands was induced by a low dose radiation associated with the activation of caspase-3 and radiation-induced necrosis was induced by a high dose radiation.
Acinar Cells ; Animals ; Apoptosis ; Caspase 3* ; Head ; Humans ; Male ; Neck ; Necrosis ; Rats* ; Rats, Sprague-Dawley ; Submandibular Gland*

PURPOSE: This study was designed to compare the clinical and radiologic outcome of the patients who underwent percutaneous vertebroplasty among the groups based on follow-up period and BMD. MATERIALS AND METHODS: A total of 99 patients (171 vertebral bodies) underwent percutaneous vertebroplasty from January 2001 to September 2003. The patients were divided into 3 groups by follow-up periods, and also divided into 2 groups by BMD. We investigated the difference of radiologic and clinical effects among the groups. Radiologic findings was assessed as vertebral height restoration rate and rate of reduction loss by measurement of the height of vertebral body. The clinical outcomes were graded into 5. The statistical analysis was done using Chi-squire test and Independent-samples T test. RESULTS: Among the groups divided by follow-up period, there was no statistically significant difference of clinical and radiologic results except the rate of reduction loss between group I and group III (p>0.05). Between the groups divided by BMD, there was no statistically significant difference of clinical and radiologic results. CONCLUSION: Percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture is an efficient procedure and considered as technique producing pleasurable clinical and radiologic results regardless of follow up-period and BMD.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Osteoporosis ; Vertebroplasty*

Hypoxia, a common consequence of solid tumor growth in breast cancer or other cancers, serves to propagate a cascade of molecular pathways which include angiogenesis, glycolysis, and various cellcycle control proteins. As we have shown previously, hypoxia activates STAT5 (signal transducer and activator of transcription 5) and increases its binding activity to the GAS element in mammary epithelial cells. In this study we attempted to elucidate the mechanism by which cyclin D1 is regulated by the STAT5 protein under hypoxic conditions. Our data demonstrate that hypoxia (2% O2) or desferrioxamine (DFO) induces tyrosine and serine phosphorylation of STAT5 in human breast cancer cells (MCF-7) and mammary epithelial cells (HC11). Imunoprecipitation and subsequent Western analysis showed that Jak2 leads to the tyrosine phosphorylation and activation of STAT5a or STAT5b under hypoxic conditions. Using a transfected COS-7 cell model system, we demonstrate that the activity of a cyclin D1 promoter-luciferase construct increased under hypoxic conditions or DFO treatment. The activity of the STAT5b/cyclin D1 promoter increased significantly by 12 h of hypoxia, whereas the activity of the STAT5a/cyclin D1 promoter was unaffected under hypoxic conditions. These increases in promoter activity are predominantly mediated by the Jak2/ STAT5b signaling pathway. We have shown by EMSA that hypoxia induces STAT5 to bind to the cyclin D1 promoter (GAS-1) in MCF-7 and HC11 cells. These data suggest that STAT5b may mediate the transcriptional activation of cyclin D1 after hypoxic stimulation.
Anaerobiosis/genetics ; Animals ; Breast Neoplasms/*genetics/metabolism ; COS Cells ; Cell Hypoxia/genetics ; Cercopithecus aethiops ; Cyclin D1/*genetics ; Deferoxamine/pharmacology ; Female ; *Gene Expression Regulation, Neoplastic ; Humans ; Phosphorylation/drug effects ; Promoter Regions (Genetics) ; Protein-Tyrosine Kinase/*metabolism ; Proto-Oncogene Proteins/*metabolism ; Research Support, Non-U.S. Gov't ; Serine/metabolism ; Tumor Cells, Cultured ; Tyrosine/metabolism

PURPOSE: To evaluate the effect of Aprotinin in reducing postoperative blood loss and amount of transfusion in total knee arthroplasty. MATERIALS AND METHODS: In a prospective study, 100 patients undergoing bilateral total knee arthroplasty were investigated. A low dose Aprotinin was administred in randomly selected fifty patients and the other fifty patients were selected as control group. Postoperative blood loss, the amount of intraoperative and postoperative transfusion, preoperative and postoperative value of hemoglobin and hematocrit were evaluated and statiscally compared. Postoperative complications were assessed. RESULTS: Significant reduction in postoperative total blood loss was observed (Aprotinin group:1195 ml, control group:2216 ml). The amount of packed red blood cells transfusion was also reduced in Aprotinin group (Aprotinin group: 2.0 units, control group: 4.0 units), and fresh frozen plasma (Aprotinin group: 0.1units, control group: 1.2 units) as well. Aprotinin also reduced the decline in hemoglobin and hematocrit levels at the first, second and fourth postoperative days. There were no clinical evidence of complications such as anaphylactic shock, deep vein thrombosis, thromboembolism, myocardiac infarction and acute renal failure. CONCLUSION: Aprotinin is safe and effective in reducing postoperative blood loss and amount of blood transfusion in total knee arthroplasty.
Acute Kidney Injury ; Anaphylaxis ; Aprotinin* ; Arthroplasty* ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Humans ; Infarction ; Knee* ; Plasma ; Postoperative Complications ; Postoperative Hemorrhage ; Prospective Studies ; Thromboembolism ; Venous Thrombosis