Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

BACKGROUND: This study was conducted to compare the effects of remifentanil, lidocaine, nicardipine and nitroglycerin used in conjunction with thiopental-sevoflurane on hemodynamic changes induced by direct laryngoscopy and tracheal intubation. METHODS: Seventy-five ASA class I or II patients scheduled for elective surgery were randomly divided into 5 groups. After induction of anesthesia with thiopental, sevoflurane and rocuronium, they were administered an intravenous bolus of either saline (Group S), remifentanil 1microgram/kg (Group R), lidocaine 1.5 mg/kg (Group L), nicardipine 20microgram/kg (Group N) or nitroglycerin 2microgram/kg (Group G). Tracheal intubation was then conducted 90 seconds after the drug was administered. The systolic blood pressure, diastolic blood pressure and heart rate were measured prior to the administration of anesthesia, before intubation, at 1 min after intubation and at 3 min after intubation for each patient. RESULTS: The systolic blood pressure, diastolic blood pressure and heart rate at 1 min after intubation were significantly lower in Group R than in Group S. In addition, the systolic blood pressure and diastolic blood pressure prior to intubation were significantly lower in Group N than in Group S. CONCLUSIONS: Remifentanil 1microgram/kg was most effective at controlling hemodynamic changes induced by direct laryngoscopy and tracheal intubation when compared with lidocaine, nicardipine and nitroglycerin.
Androstanols ; Anesthesia ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Laryngoscopy ; Lidocaine ; Methyl Ethers ; Nicardipine ; Nitroglycerin ; Piperidines ; Thiopental

BACKGROUND AND OBJECTIVES: "Recovery only" ST-segment depressions are sometimes detected during an exercise treadmill test. We undertook this study in order to clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only. SUBJECTS AND METHODS: The study included 931 patients who had both a sign or symptom -limited treadmill test. Of the 66 patients who demonstrated abnormal ST-segment responses, 43 experienced ST-segment depressions during exercise (Group A) and 23 displayed such responses only during recovery (Group B). RESULTS: The positive predictive value of an exercise treadmill test for significant angiographic disease in group A (81.3%) was statistically different from the predictive value in group B (30.4%). Horizontal ST-segment depression in recovery periods and female sex were statistically significant factors favoring negative coronary angiographic results. CONCLUSION: The occurrence of horizontal mild ST-segment depression during only the recovery periodgenerally represents a "false positive" response, particularly in female patients.
Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Depression* ; Exercise Test* ; Female ; Humans

BACKGROUNDS AND OBJECTIVES: C-Reactive protein (CRP) levels are powerful predictors of cardiac complications and death in patients with unstable angina unrelated with myocardial cell damage or myocardial ischemia. This study was performed to determine the optimal timing to measure CRP to predict cardiac events in patients with unstable angina. MATERIALS AND METHOD: The study was comprised 50 patients with unstable angina (Braunwald Class IIIb). We randomized the study subjects by the time of CRP elevation (> 8mg/L): Group A (on admission, 15 patients), Group B (during hospitalization, 19 patients), and Group C (at discharge, 19 patients). RESULTS: 1) CRP levels (median and range) of Group A, B, and C were 10.6 (8.2-24.2), 12.8 (8.1-33.7), and 10.3 (8.1-18.7) mg/L, respectively (p=S). 2) During clinical follow-up at a mean duration of 12 months, there were 1 death, 1 myocardial infarction, 6 revascularization therapy (PTCA or CABG) and 11 recurrent angina. 3) In Group A, 10 cardiac events (1 myocardial infarction, 4 revascularization therapy, and 5 recurrent angina) occurred. The elevated levels of CRP predicted cardiac events during clinical follow-up with sensitivity of 53%(10/19), positive predictive value of 67%(10/15), and negative predictive value of 74%(26/35). In Group C, 13 cardiac events were occurred. Sensitivity, positive and negative predictive value to predict cardiac events of elevated levels of CRP were 68%(13/19), 68%(13/19) and 81%(25/31), respectively. 4) Elevated levels of CRP (>8mg/L) were predictors for cardiac events in patients with unstable angina (Group A; p<0.05, Group B; p<0.05, Group C; p<0.001). However, by logistic regression analysis, CRP values > 8mg/L at discharge were only predictive of cardiac events with odd ratio of 6.01 (95% CI 1.50-44.3, p<0.05). CONCLUSIONS: CRP (> 8mg/L) was elevated in 38% of patients at discharge and elevated levels of CRP at discharge were only predictive of cardiac events in patients with unstable angina.
Angina, Unstable* ; C-Reactive Protein* ; Follow-Up Studies ; Hospitalization ; Humans ; Logistic Models ; Myocardial Infarction ; Myocardial Ischemia

OBJECTIVE: This study was performed to investigate the energy expenditure at self-selected comfortable and fast walking speeds with or without plastic ankle-foot orthosis in hemiplegic patients. METHOD: Objects of this study were 10 ambulatory hemiplegic patients. To estimate oxygen consumption, we used K2 machine and measured gait speed, stride length, stride frequency, and heart rate energy expenditure index (EEI) with or without plastic ankle-foot orthosis. RESULTS: Stride length and gait speed of the hemiplegic patients with plastic ankle-foot orthosis significantly increased at their comfortable walking speed pattern. Oxygen consumption, oxygen cost and EEI significantly decreased in hemiplegic patients with plastic ankle-foot orthosis whether their gait speed pattern. CONCLUSION: The plastic ankle-foot orthosis is useful for the hemiplegic patients to increase walking speed and to reduce energy expenditure.
Energy Metabolism ; Gait ; Heart Rate ; Hemiplegia ; Humans ; Orthotic Devices ; Oxygen ; Oxygen Consumption ; Plastics* ; Walking*

OBJECTIVE: The aim of this study was to investigate the efficacy of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of neurogenic bladder with detrusor hyperreflexia (DH). METHOD: Six subjects, three women and three men with traumatic spinal cord injury who had neurogenic bladder manifested with DH and urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were tried with intravesical administration of capsaicin (1 mmol/l 100 ml) for 30 minutes. Single instillation was given in five subjects and two instillations in one. Maximal detrusor pressure and maximal bladder volume were monitored by the portable cystometer. Follow-up monitor of pressure and volume was recorded after 1 week and every 3 weeks afterwards for 21 weeks, with one exception (31 weeks). RESULTS: Average maximal detrusor pressure decreased by 50.8% and average bladder capacity at maximal detrusor pressure increased by 68% in five subjects after single instillation of capsaicin. Clinical benefit from single instillation lasted over 21 weeks and same as the subject with two instillations. Maximal effect on detrusor pressure appears during 6~9 weeks period and bladder capacity during 9~15 weeks period. Although autonomic dysreflexia in 5 of 6 subjects during instillation and macroscopic hematuria in 2 subjects during the 1st two days were noted, they were resolved spontaneously. CONCLUSION: Single and repeated intravesical instillation of capsaicin were safe and effective in the management of neurogenic bladder with DH in traumatic spinal cord injured patients.
Administration, Intravesical ; Autonomic Dysreflexia ; Capsaicin* ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Male ; Reflex, Abnormal ; Spinal Cord ; Spinal Cord Injuries ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence

OBJECTIVE: The purpose of this study is to evaluate the psychosocial factors and outcomes in young adult stroke patients. METHOD: The study group consisted of 59 stroke patients under the age of 45. Retrospective chart reviews of demographic findings, functional status, primary caregiver, marital and child status, discharge destination, employment and psychological difficulties were recorded by rehabilitation team during hospitalization. Telephone and mail surveys were carried out for the functional status, marital status, employment and social factors of the study group after discharge. RESULTS: The proportion of young adult stroke was 13.7% of all stroke patients. Young adult stroke were 20 cases (34%) of cerebral infarction and 39 cases (66%) of cerebral hemorrhage. Of the 39 married patients, 2 couples were separated. The marital adjustment skill was significantly lower in these couples than ordinary couples under age of 45. Forty-two of 51 patients were able to return to their premorbid residence. Of the 39 patients employed at the time of stroke, only 4 (10.3%) were able to return to work after discharge. Two of the 4 patients returned to school after discharge. CONCLUSION: Rehabilitation of young adult stroke patients is associated with variety of social factors including marital adjustment and returning to work.
Caregivers ; Cerebral Hemorrhage ; Cerebral Infarction ; Child ; Employment ; Family Characteristics ; Hospitalization ; Humans ; Marital Status ; Postal Service ; Psychology ; Rehabilitation ; Retrospective Studies ; Return to Work ; Stroke* ; Telephone ; Young Adult*

BACKGROUND: Genetic and environmental factors are known to affect the incidence and severity of asthma. Stimulation of beta2-Adrenergic Receptor (beta 2AR) results in smooth muscle relaxation, leading to decrease in resistance of airflow. The gene encoding the beta 2AR has recently been seguenced. The beta 2AR genotype at the polymorphic lociof codons 16, 27, 34, and 164 was known to cause changes in the amino acids. The relationships between the structure of the beta 2AR and its functions are being elucidated. PURPOSE: The gene encoding the beta 2AR was carried out to assess the frequency of polymorphisms in bronchial asthma, to determine wheather these polymorphisms have any relation to the severity, or nocturnal symptoms in bronchial asthma. METHOD: The subjects studied were 103 patients with bronchial asthma, which consisted of 30 mild episodic, 32 mild persistent, 17 moderate, and 24 severe asthma patients. The polymorphisms of the beta 2AR gene were detected by mutated allele specific amplification (MASA) method at the codons 16, 27, 34, and 164. RESULTS: The most frequent polymorphism was arginine 16 to glycine. The other two polymorphisms, valine 34 to methionine and glutamine 27 to glutamic acid occured in 11 and 6 patients respectively. The polymorphism of threonine 164 to isoleucine was not found in our enrolled patients. The homozygous polymorphism of beta 2AR gene was found in only arginine 16 to glycine (12.6%). The heterozygous polymorphisms of beta 2AR gene were in arginine 16 to glycine, valine 34 to methionine, and glutamine 27 to glutamic acid, as 65.1%, 10.7%, and 5.8% respectively in asthma patients. The presence of agrginine 16 to glycine heterozygous or/and homozygous polymorphism was associated in severe asthma (p=0.015), but there was no association between the other three polymorphisms and the severity of asthma. The frequency of the 182AR gene polymorphisms was no relation in nocturnal asthma as compared with non-nocturnal asthma. CONCLUSION: The arginine 16 to glycine polymorphism of the beta 2AR gene is the most frequently found in asthma patients and association with severe asthma. But there was no association between the polymorphism of the beta 2AR gene and nocturnal asthma.
Alleles ; Amino Acids ; Arginine ; Asthma* ; Codon ; Genotype ; Glutamic Acid ; Glutamine ; Glycine ; Humans ; Incidence ; Isoleucine ; Methionine ; Muscle, Smooth ; Polymorphism, Genetic* ; Relaxation ; Threonine ; Valine

OBJECTIVES: Primary IgA nephropathy is the most common type of glomerulonephritis, which may progress to end stage renal failure in about 30-35% of the cases. The incidence of recurrence of IgA nephropathy in transplanted kidney is approximately 50-60% but IgA nephropathy which is recurred in graft has relatively benign clinical course so the rate of graft loss due to recurrent IgA nephropathy is about 10%. Overall graft survival rate of IgA nephropathy is higher than other glomerular disorders which cause end stage renal disease according to recent clinical studies. However accurate causative disorders of end stage renal failure had seldom been reported by pathologic examination and accurate graft survival rate and recurrence rate of original disease after renal transplantation couldn't be investigated. We performed analysis of clinical outcome and prognosis for IgA group. METHODS: 1259 cases of kidney transplantation were performed in the Severance hospital between Apr 1979 and Dec.1994. We selected 178 cases of those who got renal biopsy and excluded the cases of cadaveric transplants, hepatitis B antigen carrier, diabetes mellitus and not taking cyclosporine A. 178 cases of those were divided into two groups, IgA and nonIgA group. We performed analysis of 5 year graft and patient survival rate between two groups. The IgA group was divided into two group, recurrent and not-recurrent IgA group. We also performed analysis of recurrence rate and graft survival rate between two groups. RESULTS: 1) 62 cases(35.2M) were IgA group and 116 cases were non-IgA group. 2) Male to female ratio of IgA group was 2.9:1, whose age averaged 35 years old. 3) Among 6 cases of the IgA group, 3 cases lost their graft due to chronic rejection, 2 cases due to recurrence and 1 case due to acute rejection. 4) The 5 year graft survival rate of IgA and nonIgA group were 85%, 90% each without statistical significance(p>0.05). The 5 year patient survival rate of IgA and nonlgA group after renal allograft were 100%, 97% each without statistical significance(p>0.05). 5) 266 cases of posttransplant kidney biopsies were performed and 10 cases were diagnosed as recurrent IgA nephropathy with recurrence rate of 15%. 6) Renal insufficiency was noted in 4 cases of recurrent IgA nephropathy, 2 cases of those were chronic renal failure and the other 2 cases lost their graft. The histologic findings of these cases included mesangial widening and proliferation(4 cases), glomerulosclerosis(2 cases), crescent formation(1 cases). 7) The interval between transplantation and recurrence averaged 41 months. 24hr proteinuria and serum level of creatinine at the time of diagnosis averaged 2.6g and 2.2 mg/dl each. 8) Male to female ratio, age, HLA type and degree of HLA match showed no significant difference between nonrecurrent and recurrent IgA group in graft but 5 year graft survival rate of recurrent IgA group was lower than nonrecurrent group with statistical significance(71% vs 83%, p<0.05). CONCLUSION: Recurrent IgA nephropathy in transplanted kidney might be one of major cause of graft loss with chronic rejection. However precise pathologic examination of before k after transplantation on larger patient population and more long term follow-up are advised.
Adult ; Allografts ; Biopsy ; Cadaver ; Creatinine ; Cyclosporine ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Graft Survival ; Hepatitis B ; Humans ; Immunoglobulin A* ; Incidence ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation* ; Male ; Prognosis ; Proteinuria ; Recurrence ; Renal Insufficiency ; Survival Rate ; Transplants

No abstract available.
Gram-Positive Bacterial Infections* ; Teicoplanin*