BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

PURPOSE: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. METHODS: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. RESULTS: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. CONCLUSION: NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.
Adult ; Body Mass Index ; Demography ; Diarrhea ; Enteral Nutrition ; Hospitalization ; Humans ; Hyperammonemia ; Intensive Care Units ; Korea ; Length of Stay ; Multicenter Studies as Topic ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition ; Referral and Consultation ; Retrospective Studies ; Vitamins

A schwannoma is a benign tumor that originates from the peripheral nerve sheath. Schwannomas occur most commonly in the head and neck region involving the brachial plexus and the spinal nerves. The lower limbs are less commonly affected. This paper presents a case of a patient with a schwannoma showing atypical localization at the digital nerve of the foot causing neurological symptoms.
Brachial Plexus ; Foot ; Head ; Humans ; Lower Extremity ; Neck ; Neurilemmoma* ; Peripheral Nerves ; Spinal Nerves ; Toes*

PURPOSE: Conventional laparoscopy using a two-dimensional (2D) has limited performance because of insufficient representation of the stereoscopic effect. Development of three-dimensional (3D) imaging technology has improved depth perception, shortened the execution time and reduced error number. This study was designed to identify the effects of 3D imaging on surgical performance for skilled professionals and surgical residents. METHODS: Two laparoscopic skills tasks, each with three repetitions, were performed by seven experienced laparoscopic surgeons, two minimally experienced laparoscopic surgeons, and three inexperienced surgical residents under both 2D and 3D conditions with two cadavers. Outcome measures were time for task completion and subjective assessment of performance. RESULTS: Suturing was completed by all participants and anchoring with V-Loc was performed by 10 participants. Suturing and anchoring time were significantly shorter with 3D laparoscopic in all participants (suturing time, p=0.011; anchoring time, p=0.005). Significant differences were observed between experienced and minimally experienced surgeons (suture time, p=0.021; anchoring time, p=0.018). There was no significant difference among inexperienced surgical residents, but they preferred 3D imaging over 2D. CONCLUSION: 3D laparoscopy is associated with a significantly shorter time for performance by experienced surgeons. Our results suggest that 3D laparoscopy will be helpful for surgeons conducting laparoscopic procedures.
Cadaver* ; Depth Perception ; Imaging, Three-Dimensional ; Laparoscopy* ; Outcome Assessment (Health Care) ; Surgeons

Primary diffuse large B-cell lymphoma of the seminal vesicle is an extremely rare disorder, with only two cases reported in the English literature. Here, we present imaging findings of a case of primary diffuse large B-cell lymphoma of the seminal vesicle. On transrectal ultrasonography, the mass presented as a 3.0-cm-sized heterogeneous, hypoechoic lesion in the right seminal vesicle. Computed tomography (CT) revealed a mass with rim-like enhancement in the right seminal vesicle. On magnetic resonance imaging (MRI), the tumor showed iso-signal intensity on T1-weighted images and heterogeneously intermediate-high signal intensity on T2-weighted images. The tumor showed rim-like and progressive enhancement with non-enhancing portion on dynamic scanning. Diffusion restriction was observed in the mass. On fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) imaging, a high standardized uptake value (maxSUV, 23.5) by the tumor was noted exclusively in the right seminal vesicle.
B-Lymphocytes* ; Diffusion ; Electrons ; Lymphoma ; Lymphoma, B-Cell* ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; Positron-Emission Tomography ; Seminal Vesicles* ; Ultrasonography

Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.
Asphyxia* ; Death, Sudden ; Deglutition Disorders ; Endoscopy ; Esophagus ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Larynx ; Middle Aged ; Mouth ; Pharynx ; Polyps* ; Sensation ; SNARE Proteins ; Snoring ; Vocal Cords

BACKGROUND: Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. The diagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influence the yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated the effects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield of TBLB. METHODS: We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters (5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLB and flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of the procedures with respect to diagnosis, distance from the pleura, and size of the lesion. RESULTS: The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantly better than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly, when the distance from the pleura was < or = 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscope were higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. CONCLUSION: A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing in conjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.
Biopsy* ; Biopsy, Fine-Needle ; Bronchoscopes* ; Bronchoscopy ; Diagnosis ; Humans ; Lung Neoplasms ; Lung* ; Pleura

PURPOSE: Laparoscopic appendectomy is a common procedure for treatment of appendicitis. However, in some complicated cases, like periappendiceal abscess, deciding on treatment options is very challenging. Early appendectomy or interval appendectomy may be possible, but remains controversial. METHODS: We prospectively studied the advantages of interval appendectomy in 21 patients with periappendiceal abscess using a laparoscopic method versus 14 patients with immediate initial laparotomy. RESULTS: In the interval appendectomy group (INT group), in periappendiceal abscess, use of a laparoscopic method was advantageous in terms of operation time (p<0.001), less fasting time (p<0.001), and fewer postoperative complications (p=0.032). However, the total cost in the INT group was 1,686,000+/-940,000 South Korean won (KRW) compared with 1,506,000+/-322,000 KRW in the early appendectomy group (EAR group) (p=0.007) because patients in the INT group required two hospital visits. The total length of hospital stay postoperatively, was 7.31+/-2.726 days in the INT group, compared with 9.21+/-3.378 days in the EAR group (p=0.537). CONCLUSION: We recommend interval appendectomy as the preferable approach for the periappendiceal abscess, as it can result in more favorable postoperative surgical outcomes, fewer complications, and less antibiotic usage.
Abscess* ; Appendectomy* ; Appendicitis ; Cost-Benefit Analysis ; Ear ; Fasting ; Humans ; Laparotomy ; Length of Stay ; Postoperative Complications ; Prospective Studies

PURPOSE: Laparoscopic appendectomy is a common procedure for treatment of appendicitis. However, in some complicated cases, like periappendiceal abscess, deciding on treatment options is very challenging. Early appendectomy or interval appendectomy may be possible, but remains controversial. METHODS: We prospectively studied the advantages of interval appendectomy in 21 patients with periappendiceal abscess using a laparoscopic method versus 14 patients with immediate initial laparotomy. RESULTS: In the interval appendectomy group (INT group), in periappendiceal abscess, use of a laparoscopic method was advantageous in terms of operation time (p<0.001), less fasting time (p<0.001), and fewer postoperative complications (p=0.032). However, the total cost in the INT group was 1,686,000+/-940,000 South Korean won (KRW) compared with 1,506,000+/-322,000 KRW in the early appendectomy group (EAR group) (p=0.007) because patients in the INT group required two hospital visits. The total length of hospital stay postoperatively, was 7.31+/-2.726 days in the INT group, compared with 9.21+/-3.378 days in the EAR group (p=0.537). CONCLUSION: We recommend interval appendectomy as the preferable approach for the periappendiceal abscess, as it can result in more favorable postoperative surgical outcomes, fewer complications, and less antibiotic usage.
Abscess* ; Appendectomy* ; Appendicitis ; Cost-Benefit Analysis ; Ear ; Fasting ; Humans ; Laparotomy ; Length of Stay ; Postoperative Complications ; Prospective Studies

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.
Anesthesia ; Antley-Bixler Syndrome Phenotype ; Cartilage ; Constriction, Pathologic ; Craniosynostoses ; Humans ; Infant ; Infant, Newborn ; Synostosis