OBJECTIVE: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. METHODS: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). RESULTS: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p < 0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p < 0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p < 0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p < 0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p < 0.05). CONCLUSION: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.
Antiemetics ; Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Electronic Health Records ; Gallbladder ; Heart Rate ; Hemodynamics ; Humans ; Neostigmine* ; Postoperative Nausea and Vomiting ; Respiration* ; Retrospective Studies ; Tachycardia

BACKGROUND: Dapagliflozin, a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, lowers blood glucose by reducing glucose reabsorption at the proximal renal tubule in an insulin-independent manner. We aimed to evaluate the efficacy and safety of dapagliflozin and to identify the risk factors of adverse drug events in patients with type 2 diabetes. METHODS: As an institutional pharmacovigilance review activity, we reviewed data from medical records of 455 patients with type 2 diabetes who received dapagliflozin therapy from July 2014 to August 2015 in Seoul National University Hospital. We analyzed the changes in laboratory data and examined the characteristics of dapagliflozin users who showed adverse effects. RESULTS: Mean changes in HbA1c and fasting serum glucose level from baseline to second visit were −0.42% (8.07 ± 1.51% to 7.65 ± 1.31%, P < 0.001) and −22.9 mg/dL (167.8 ± 48.5 mg/dL to 144.9 ± 37.6 mg/dL, P < 0.001), respectively. Adverse drug events observed during this study were lower urinary tract symptoms (7.7%), dehydration-related symptoms (6.1%), ketonuria (3.4%), hypoglycemia (3.4%), and urogenital infection (4.2%). Thiazide use, age, insulin use, number of anti-diabetic drugs, gender and history of urogenital infection were the risk factors for adverse drug events (P < 0.05). CONCLUSION: Dapagliflozin significantly improved hyperglycemia in patients with type 2 diabetes without serious adverse drug events. The incidences of adverse drug events were was similar to those ofthat in the previous studies.
Blood Glucose ; Diabetes Mellitus ; Drug-Related Side Effects and Adverse Reactions ; Fasting ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Incidence ; Insulin ; Ketosis ; Kidney Tubules, Proximal ; Lower Urinary Tract Symptoms ; Medical Records ; Pharmacovigilance* ; Risk Factors ; Seoul

Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). The survival outcome of pediatric LT is excellent and similar regardless of age. LTs in infancy are not riskier than those of children.
Adolescent ; Age Factors ; Child ; Child, Preschool ; End Stage Liver Disease/mortality/*surgery ; Female ; Graft Rejection/epidemiology ; Graft Survival ; Herpesviridae Infections/etiology ; Humans ; Infant ; Liver Transplantation/*adverse effects/*statistics & numerical data ; Lymphoproliferative Disorders/*etiology ; Male ; Proportional Hazards Models ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Vascular Diseases/etiology

PURPOSE: The purpose of this study was to determine if timing of enterostomy repair described in terms of postmenstrual age (PMA) could influence postoperative course, complications, and growth. METHODS: Under the Institutional Review Board approval, records of preterm infants who underwent enterostomy and subsequent repair from 2007 to 2013 at Seoul national university children's hospital were reviewed. Records of infants with congenital anomalies were excluded. Data collected included baseline characteristics, PMA, weight at enterostomy and enterostomy repair, postoperative course, enterostomy repair-related complications, and follow-up growth after repair. For analysis, patients were divided into 2 groups: group 1 with enterostomy repaired before PMA 40 weeks; and group 2 with enterostomy repaired since PMA 40 weeks. RESULTS: There were 54 infants: 16 in group 1 and 38 in group 2. The median weight at the time of enterostomy repair was greater in group 2 compared to those of group 1. Group 1 infants had more complications and had to be ventilated longer after enterostomy repair. They required longer periods of total parenteral nutrition and took longer to reach full enteral feeding. Group 1 infants also needed longer hospital stay after enterostomy repair. No statistical difference was observed in growth after discharge. CONCLUSION: The timing of enterostomy repair influences postoperative course and complications significantly. Therefore, it is recommended that enterostomy repair should be withheld until PMA 40 weeks. For predicting long term prognosis, more studies will be required.
Enteral Nutrition ; Enterostomy* ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parenteral Nutrition, Total ; Prognosis ; Seoul

PURPOSE: Laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter insertion is used instead of open CAPD insertion because additional measures to prevent complications can be made without a conventional laparotomy. This study compared the early experience of laparoscopic CAPD catheter insertion with open CAPD insertion in children. METHODS: Between January 2006 and May 2011, 52, 16 and 36 patients who underwent CAPD insertion, laparoscopic CAPD insertion and open CAPD insertion, respectively, for end stage renal disease at Seoul National University Children's Hospital were enrolled in this study. The clinicopathological factors, operative factors and outcomes were analyzed by a retrospective medical record review. RESULTS: The mean operative time of the laparoscopic group was longer than that of the open groups (78 minutes vs 60 minutesm, p value=0.079). In the laparoscopic group, 3 patients underwent closure of the processus vaginalis and the occurrence of an inguinal hernia was prevented, whereas 3 patients in the open group underwent herniorrhaphy for an inguinal hernia. The mean period of catheter use in the laparoscopic and open group was 201 and 984 days, respectively. Complications occurred more frequently in the open group than in the laparoscopic group (14 patients (38.9%) vs. 2 patients (12.5%), p value=0.059). Peritonitis (19.4%) was the most common complication, which occurred only in the open group, followed by catheter obstruction due to omental wrapping. Catheter migration occurred more frequently in the open group (20%) than the laparoscopic group (12.5%). CONCLUSION: These results suggest that laparoscopic CAPD catheter insertion can be a suitable method for CAPD catheter insertion in children.
Catheter Obstruction ; Catheters ; Child ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Kidney Failure, Chronic ; Laparoscopy ; Laparotomy ; Medical Records ; Operative Time ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Retrospective Studies

The survival rate for rhabdomyosarcoma (RMS) has significantly improved after the introduction of combined multimodality treatment. We report the 20-year treatment outcome of pediatric rhabdomyosarcoma in a single institution. The medical records of 16 patients treated for rhabdomyosarcoma between December 1986 and August 2007 at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were retrospectively reviewed. Mean age at diagnosis was 7.1 years (range: 1.3 -14.2 years). Retroperitoneum was the most common primary site (n=7, 43.8%), and embryonal type was predominant (n=11, 6%). Before the treatment, most patients were in advanced TNM stage (stage III 50%, IV; 25%). The patient distribution according to the Intergroup Rhabdomyosarcoma Study Clinical Grouping System (IRS-CGS) was as follows; Group I 31.3%, Group II 12.5%, Group III 31.3% and Group IV 25%. Patients were classified into three groups according to the extent of resection of the primary tumor; complete resection (CR, n=5; 31.3%), gross total resection (GTR, n=7; 43.8%) and incomplete resection (IR, n=4; 25%). Recurrence was observed in 9 patients (56.3%) while there was no recurrence in CR patients. All patients with recurrence were identified as moderate or high-risk according to the IRS-V Risk Group. Pre-treatment TNM stage of RMS in our institution was advanced with aggressive clinical feature, however post- surgical conditions according to IRS-CGS were similar to the previous reports by IRS. This suggests that down-staging of IRS-CGS was achieved with multimodality treatment with CR or GTR. It also suggests that complete resection is the most important prognostic factor in the treatment of RMS in children. Patients classified as moderate or high-risk need close follow-up due to high recurrence rate. In case of localized recurrence, better outcome may be achieved with multimodality treatment including limited surgery.
Child ; Follow-Up Studies ; Humans ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Rhabdomyosarcoma ; Survival Rate ; Treatment Outcome

BACKGROUND/AIMS: Although polyethylene glycol (PEG) solution is safe and effective for bowel preparation for colonoscopy, its salty taste as well as the required large volume limits its use. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the SF-PEG solution with the standard PEG solution in regard to the quality of bowel preparation, the degree of patients' satisfaction and the side effects in Korean patients. METHODS: From July through September in 2006, 100 patients who underwent colonoscopic polypectomy were prospectively enrolled. They were randomly assigned to receive either PEG or SF-PEG solution. The quality of bowel preparation was assessed by one colonoscopist who was blinded with regard to the type of preparation used. Detailed questionnaires were used to assess the patients' tolerance and satisfaction. The serum biochemical parameters were measured before and after bowel cleansing. RESULTS: The numbers of patients whose quality of bowel preparation was excellent, good, fair and poor were 2, 43, 5 and 0 in PEG group, while this was 0, 41, 9 and 0 in SF-PEG group, respectively (p=0.118). The side effects were not different between the groups. The visual analog scale score of the patients' satisfaction was 6.4+/-2.4 in the PEG group and 5.8+/-2.8 in the SF-PEG group (p=0.237). The changes of serum biochemical parameters were also not different. CONCLUSIONS: The SF-PEG solution shows similar effectiveness and safety for bowel preparation for colonoscopy when compared to the standard PEG solution. The SF-PEG solution is a good solution to use for colonoscopy preparation.
Colonoscopy ; Humans ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Sodium ; Sulfates ; Surveys and Questionnaires

BACKGROUND/AIMS: There are a limited number of studies concerning the outcomes of diverticulitis in the Oriental population. We sought to evaluate the clinical features and the long-term outcomes of diverticulitis in Korean patients. METHODS: We retrospectively reviewed the clinical courses of 104 patients (59 men, 45 women; median age 48.5 years [range: 24-83 years]) hospitalized for their first episode of diverticulitis between 1989 and 2005. RESULTS: Right-sided diverticulitis was more common (71/104, 68%). However, the proportion of left-sided diverticulitis increased as age increased. Thirty-two patients underwent operations: 30 because of complications and 2 because of presumed appendicitis. Left-sided diverticulitis was an independent risk factor for complications (OR=7.6, p<0.001), and it required surgical treatment more often than right-sided diverticulitis did (61% vs. 17%, p<0.001). Eighty-five patients were followed for a median of 36 months. Four of the 62 medically treated patients developed recurrence of diverticulitis, with a 3-year cumulative recurrence rate of 4.8%. None of the 4 recurrences showed complications, and all were successfully managed using conservative treatment. No predictive factors for the recurrence of diverticulitis could be determined. CONCLUSIONS: The recurrence rate and risk of complications associated with recurrence are low in patients treated conservatively for the first episode of diverticulitis. Therefore, elective surgery to prevent recurrence and complications should be utilized sparingly in patients with diverticulitis.
Appendicitis ; Diverticulitis ; Diverticulitis, Colonic ; Diverticulosis, Colonic ; Humans ; Male ; Recurrence ; Retrospective Studies ; Risk Factors

Inflammatory myofibroblastic tumor (IMT) is a rare reactive lesion characterized by the feature of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. Extrapulmonary IMTs in children have been described involving the mesentery, omentum, retroperitoneum, abdominal soft tissues, liver, bladder, mediastinum, head and neck, extremity, appendix, and kidney. Medical records of children treated with abdominal IMT between 1985 and 2005 were reviewed retrospectively. Seven children were treated for IMT with the mean age of 3y 2m (range, 1y 1m to 14y). Tumors were located in transverse mesocolon (n=2), omentum (n=1), porta hepatis (n=2), complex site (antrum, duodenum, common bile duct, porta hepatis) (n=2). The symptoms included abdominal mass, fever, jaundice, abdominal pain and anemia. The masses were excised totally in transverse mesocolon, omentum IMT and there is no evidence of recurrence (follow-up periods: 6y 8m, 8y 9m, 4y 10m). In porta hepatis IMT, liver transplantations were performed and there is no evidence of recurrence (follow period: 6y 8m, 8y 7m). In one case of complex site IMT, partial excision of mass was performed and he still survived with no change of the residual tumor during follow-up period. The other one of complex site IMT denied further treatment after the biopsy. In conclusion, complete surgical excision including liver transplantation and close follow-up are mandatory for the abdominal IMT in child.
Abdominal Pain ; Anemia ; Appendix ; Biopsy ; Child ; Common Bile Duct ; Duodenum ; Extremities ; Fever ; Follow-Up Studies ; Head ; Humans ; Jaundice ; Kidney ; Liver ; Liver Transplantation ; Mediastinum ; Medical Records ; Mesentery ; Mesocolon ; Myofibroblasts ; Neck ; Neoplasm, Residual ; Omentum ; Recurrence ; Retrospective Studies ; Urinary Bladder

PURPOSE: The purpose of this study was to determine the clinical features of focal nodular hyperplasia (FNH) and investigate its diagnosis and treatment. METHODS: Eleven patients with FNH treated from January 1997 to January 2007 were analyzed. The clinical findings of pathologically proven FNH were retrospectively reviewed. RESULTS: Among the eleven patients with 18 masses, the mean age was 29.5 (11~57) and the gender ratio (male:female) was 4:7. Four patients had clinical symptoms. Six patients had a solitary mass and five had multiple masses. The mean tumor diameter was 2.73 +/- 1.82 cm. The overall rate of a correct preoperative diagnosis was 0% (0/4) by ultrasound, 36.3% (4/11) by CT and 20.0% (2/10) by MRI. Only two patients had a central stellate scar in the mass. All patients underwent hepatic resection without complication. CONCLUSION: The results of this study showed that the combination of Dynamic CT and dual contrast MRI are important diagnostic methods for FNH. However, a definite preoperative diagnosis of FNH, without a central stellate scar, is very difficult. Surgical resection is recommended for patients with an uncertain diagnosis or clinical symptoms.
Cicatrix ; Diagnosis ; Focal Nodular Hyperplasia* ; Humans ; Liver* ; Magnetic Resonance Imaging ; Retrospective Studies ; Ultrasonography