Situs inversus totalis is a rare inherent disease in which the thoracic and abdominal organs are transposed. Symptoms of appendicitis in situs inversus (SI) may appear in the left lower quadrant, and the diagnosis of appendicitis is very difficult. We report a case of left-sided appendicitis diagnosed preoperatively after dextrocardia that was detected by chest X-ray, although the chief complaint of the patient was left lower-quadrant pain. The patient underwent an emergent laparoscopic appendectomy under the diagnosis of appendicitis after abdominal computed tomography (CT). In patients with left lower quadrant pain, if the chest X-ray shows dextrocardia, one should suspect left-sided appendicitis. A strong suspicion of appendicitis and an emergency laparoscopic operation after confirmation of the diagnosis by imaging modalities including abdominal CT or sonography can reduce the likelihood of misdiagnosis and complications including perforation and abscess. Laparoscopic appendectomy in SI was technically more challenging because of the mirror nature of the anatomy.
Abscess ; Appendectomy ; Appendicitis ; Dextrocardia ; Diagnostic Errors ; Emergencies ; Humans ; Situs Inversus ; Thorax

PURPOSE: Although cardiac toxicity is a key parameter of significant toxicity, in antidepressant intoxication, there are few studies on the cardiac toxicity of serotonin reuptake inhibitor and the intoxication with the new generation of antidepressants. The aim of this study is to investigate the relative cardiac toxicity of serotonin reuptake inhibitor and intoxication with the new generation of antidepressants as compared with that of tricyclic antidepressant intoxication. METHODS: We retrospectively reviewed the medical records of 109 antidepressant intoxicated patients who visited the Emergency Department from January, 2005 to December, 2009 to collect and analyze the demographic and clinical data. Sixteen patients were excluded. The enrolled seventy eight patients were classified into three groups: the tricyclic antidepressant group (TCA) (n=32), the selective serotonin reuptake inhibitor subgroup (SSRI) (n=28) and the new generation antidepressant subgroup (NGA) (n=18). RESULTS: The demographic and clinical data of the SSRI and NGA groups were not significantly different from that of the TCA group. The QRS duration of the SSRI subgroup (86.4+/-12.0 msec) and the NGA subgroup (91.8+/-11.9 msec) was not significantly different from that of the TCA group (90.0+/-13.5msec) (p=0.598). CONCLUSION: Intoxication with SSRI and the new generation antidepressants seemed to show significant cardiac toxicity, like what is seen in tricyclic antidepressant intoxication. Clinicians must pay attention to SSRI and new generation antidepressant intoxication.
Antidepressive Agents ; Emergencies ; Humans ; Medical Records ; Retrospective Studies ; Serotonin

Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury.
Emergencies ; Humans ; Korea ; Spleen ; Splenectomy ; Splenic Rupture

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.
Botulinum Toxins ; Botulinum Toxins, Type A ; Consensus ; Foot ; Forehead ; Handling (Psychology) ; Humans ; Hypertrophy ; Korea ; Neurotoxins ; Rejuvenation

PURPOSE: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. MATERIALS AND METHODS: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30degrees) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. RESULTS: Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05). CONCLUSION: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.
Analgesia ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, General ; Anesthesiology ; Arthroplasty ; Bupivacaine ; Hip ; Hip Joint ; Humans ; Morphine ; Muscles ; Prospective Studies

PURPOSE: This study compared the postoperative outcomes and complications between laparoscopic totally extraperitoneal (TEP) hernia repair and open Lichtenstein hernia repair. METHODS: A total of 64 cases (30 cases by the TEP method and 34 cases by Lichtenstein repair) were enrolled in this study. The operative time, the hospital stay, the VAS score, the amount of analgesic used, the postoperative complications and recurrence were compared between the 2 methods. RESULTS: The mean operative time was 71 min for the TEP group, which was not significantly longer than that for the Lichtenstein group (66 min). The mean postoperative hospital stay was 3.7 days for the TEP group, which was significantly shorter than that for the Lichtenstein group (4.2) (p=0.035). The mean postoperative analgesic dose was 0.9+/-0.7 and 1.1+/-1.0 within 24 hours and 0.2+/-0.5 and 0.7+/-0.8 after 24 hours, respectively. The dose of analgesic after 24 hours was significantly lower for the TEP group (p=0.011), but the dose within 24 hours and the total dose was not significantly different. The VAS score was 2.3+/-1.0 and 2.6+/-0.9 at 12 hrs and 1.2+/-0.8 and 1.7+/-0.8 at 48 hrs, respectively. The VAS score was significantly lower for TEP group than that for the Lichtenstein group at 48 hrs (p=0.011), but there was no significant difference between the groups at 12 hrs. There was one recurrence in the TEP group. CONCLUSION: For the TEP group, the hospital stay was significantly shorter than that for the Lichtenstein group and this is maybe because the postoperative pain after 24 hours from the operation was less for the TEP group. Laparoscopic TEP repair may be performed efficiently with an acceptable operating time and a shorter hospital stay, as compared to open Lichtenstein hernia repair.
Hernia ; Herniorrhaphy ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pyrazines ; Recurrence

Various bacteria were isolated from the casing layer soil of the culture bed of P. ostreatus and their role in fruiting body induction of the edible mushroom, P. ostreatus, was investigated. Analysis of the bacterial community isolated from the casing layer soil revealed that the composition of genera and number of cultivable bacteria were different for each sterilizing treatment. Bordetella was predominant in the bulk soil whereas Flavobacterium was predominant after sterilization of the casing layer soil. Fluorescent Pseudomonas was predominant in the non-sterilized casing layer soil. Total number of the bacterial genera in the casing layer soil was higher than that in the bulk soil. In particular, an increase in the fluorescent Pseudomonas population was observed in the non-sterilized casing layer accompanied by induction of fruiting body and enhanced mushroom production yield. The results suggested that specific bacterial populations in the casing layer play an important role in the formation of primodia and the development of basidiome in P. ostreatus.
Agaricales ; Bacteria ; Bordetella ; Flavobacterium ; Fruit ; Pleurotus ; Pseudomonas ; Soil ; Sterilization

Cholangiocarcinoma is usually diagnosed at the advanced stage because early symptoms and signs are relatively infrequent. The preoperative diagnosis of early extrahepatic bile duct cancer in common bile duct is uncommon. Also, an extrahepatic bile duct cancer arising from the lower portion of the common bile duct is usually papillary and rarely nodular or sclerosing. We decribe a case, preoperatively diagnosed as early extrahepatic bile duct cancer in lower portion of common bile duct, nodular type on endoscopic retrograde cholangiography. It was incidentally detected by the slight elevation of gamma-glutamyl transpeptidase without any symptoms. An endoscopic retrograde cholangiography showed abrupt narrowing of the intrapancreatic portion of the common bile duct with irregular and nodular filling defect. The lesion was confined to mucosa on the endoscopic ultrasonography. This patient was diagnosed as early extrahepatic bile duct cancer and underwent Whipple's operation. A histopathologic examination of resected specimen revealed to be moderately differentiated adenocarcinoma at stage 1 (T1N0Mo) in the extrahepatic bile duct.
Adenocarcinoma ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Cholangiography ; Common Bile Duct ; Diagnosis ; Endosonography ; gamma-Glutamyltransferase ; Humans ; Mucous Membrane

Eighteen patients with primary hyperparathyroidism were treated by one of the authors (SKO) from 1981 through 1988 at the Department of Surgery, Seoul National University Hospital and the data were analyzed retrospectively. Eighteen patients comprised 6 males and 12 females, with the male to female ratio of 1 to 2. The age distribution was between 18 and 64 years. The chief complaints were associated with skeletal symptoms in 9 urinary symptoms in 5, and neurologic manifestation in 1 patient. There were 3 patients with asymptomatic hypercalcemia. All patients showed hypercalcemia and hypophosphatemia was found in 11 patients. Serum PTH level was elevated in 13 cases. performing preoperative localization with computed tomorgam, ultrasonogram and thallium-technetium subtraction scan, positive localization was made in 62.5% (10/16), 53.8% (7/13) and 85.7% (12/14), respectively. one patient, angiography and selective venous sampling were peformed and positive localization was made. All patients were treated by surgery. There were 17 patients with solitary adenoma and one with double tumors. Pathologic findings revealed adenoma of the parathyroid in all patients except one which was proved later to be carcinoma. There were no recurrent cases except one with carcinoma. There were no postoperative complications. primary hyperparathyroidism is a very rare disease in Korea. Causes of primary hyperparathyroidism in our study was confined to tumors of the parathyroid, such as adenoma and carcinoma.There was no hyperplasia causing primary hyperparathyroidism. Thallium-technetium subtraction scan was proved to be the best method for localization of the parathyroid tumors Excision of the tumor with involved parathyroid followed by frozen-section biopsy of the univolved parathyroid was the best way to treat primary hyperparathyroidism in our study.
Adenoma ; Age Distribution ; Angiography ; Biopsy ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hyperplasia ; Hypophosphatemia ; Korea ; Male ; Methods ; Neurologic Manifestations ; Postoperative Complications ; Rare Diseases ; Retrospective Studies ; Seoul ; Ultrasonography

Cases of sarcomatoid renal cell carcinoma are very rare. It has been known that sarcomatoid renal cell carcinoma is an epithelial cell variant that has been metaplastically transformed with a very poor prognosis. Diagnosis of sarcomatoid renal cell carcinoma is performed by examining a nephrectomy specimen to see if epithelial and sarcomatoid components are variously mixed together. Therefore, the aim of this paper is to report five cases of sarcomatoid renal cell carcinoma.
Carcinoma, Renal Cell* ; Diagnosis ; Epithelial Cells ; Nephrectomy ; Pathology ; Prognosis