2014–2017 Nationwide Bariatric and Metabolic Surgery Report in Korea

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.

Effect of Combined Hyperventilation and Mannitol on Cerebral Blood Flow and Cerebral O2 Metabolism during a Craniectomy / 대한마취과학회지

BACKGROUND: There are therapies to lower intracranial pressure (ICP) including head elevation, hyperventilation, diuretics injection, intravenous mannitol, hypothermia, cerebrospinal fluid drainage, and cerebral resection in neurosurgical patients. However in recent reports, hyperventilation followed by mannitol administration may lead to cerebral ischemia. Therefore, we investigated the effect of 0.5-1.0 g/kg mannitol administration on jugular venous oxygen saturation (SjVO2) and cerebral arterial- jugular venous oxygen content difference (AVDO2) at PaCO2 25-30 mmHg and 35-40 mmHg in patients undergoing neurosurgery. METHODS: We studied 17 patients undergoing neurosurgery in the Ajou University Hospital. Anesthesia was induced with fentanyl, midazolam, thiopental, and vecuronium, and maintained with O2-Air-Isoflorane, a continuous infusion of fentanyl, and vecuronium. Patients were divided into two groups. Group 1 (n = 10) which is PaCO2 25-30 mmHg and Group 2 (n = 7) which is PaCO2 35-40 mmHg by controlling ventilator. Measurements of SjVO2 and AVDO2 in following time intervals: I = preinjection of mannitol, II = postinjection 20 minutes of mannitol, III = postinjection 40 minutes of mannitol were obtained for each group. 0.5-1.0 g/kg mannitol was administered intravenously just at duramater opening. RESULTS: Hemodynamics and hematologics were not significantly different among the two groups. SjVO2 of each group are as follows; Group 1; I (70.3+/-8.1%), II (66.3+/-6.9%), III (69.1+/-7.9%) and Group 2; I (78.6+/-7.4%), II (75.1+/-8.1%), III (76.0+/-11.2%). Hyperventilation significantly decreased SjVO2. AVDO2 was not significantly different but SjVO2 in II was significantly decreased compared with I and III in Group 1 (20% patients). CONCLUSIONS: Mannitol produced a change of SjVO2 and AVDO2 during hyperventilation. Therefore, intravenous mannitol during hyperventilation should be given cautiously according to the patients status because it may cause cerebral ischemia in critical patients.

A Case of Cerebrospinal Fluid Flow through Subcutaneous Fibrous Tract after Removal of Distal Ventriculoperitoneal Shunt Catheter: Case Report

We report a case of the functioning long subcutaneous fibrous tract that drained cerebrospinal fluid into peritoneal cavity. A 13 year-old boy whose distal catheter had been removed 10 years before was admitted with intermittent headache and deteriorated mentality. On physical examination, a hard and firm long subcutaneous catheter-like structure was palpable along the tract of the old distal catheter in the neck, anterior chest and abdomen. We could see hydrocephalus on the computed tomography(CT) scan and passage of radioisotope through the long left subcutaneous fibrous tract into abdomen on the shunt function test. After ventriculoperitoneal shunt in the right side, he improved clinically and brain CT scan showed decreased size of ventricles.

Comparison of Shock Wave Lithotripsy and Ureteroscopy as a Primary Therapy for Lower Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: Controversy continues over the initial approach to lower ureteral calculi; in situ shock wave lithotripsy(SWL) versus ureteroscopy(URS). We compared the efficacy and the safety of each procedure to help determine which is more appropriate as initial management for lower ureteral calculi. MATERIALS AND METHODS: From May 1996 through August 1997, 70 patients had been treated at our department for lower ureteral stones. 35 patients underwent URS and 35 patients underwent SWL with SDS-3000. We retrospectively reviewed success rate of stone removal, complication rate, anesthesia and hospitalization. RESULTS: Patient age and stone size were similar in two groups. Stone free rates were 94.3% for URS, 57.1% after 1 session and 77.1% after 3 sessions of SWL. 2 cases of ureteral injuries were developed in URS group while there was no complication in SWL group. CONCLUSIONS: Regarding our results, SWL is safer than URS, but has lower stone free rate than URS. Although URS is more invasive procedure with higher complication rate, it has higher stone free rate. URS is indicated especially in patients who want to become stone-free as soon as possible.

Detection of Prostate Cancer by Digital Rectal Examination, Serum PSA and Transrectal Ultrasonography / 대한비뇨기과학회지

PURPOSE: We designed the study to compare the efficacy of digital rectal examination(DRE), serum prostate specific antigen(PSA) & transrectal ultrasonography (TRUS) for the early detection of prostate cancer. MATERIALS AND METHODS: We analyzed the result of the prostate biopsies of 162 patients with abnormal hard nodule or asymmetricity on DRE, elevated serum PSA(> 4ng/ml) or hypoechoic lesion in peripheral zone on TRUS from August 1994 to June 1997. RESULTS: Of 162 patients, 26 patients(16%) had prostate cancer and 136 patients(84%) were diagnosed as benign prostatic hyperplasia. DRE, serum PSA and TRUS had sensitivities of 77%, 100% and 92%, respectively and positive predictive values(PPVs) of 48%, 26% and 19%, respectively. The sensitivities of high serum PSA(> 4ng/ml) with positive DRE, positive DRE with positive TRUS and high serum PSA with positive TRUS were 77%, 73% and 92%, respectively and the PPVs were 65%, 51% and 34%, respectively. In cases both DRE and TRUS were positive with high serum PSA, sensitivity and PPV were 73% and 68%, respectively CONCLUSIONS: The combination of DRE and serum PSA would be recommended as a first line examination in the diagnosis of prostate cancer regarding the sensitivity and PPV.

Two Cases of Transitional Cell Carcinoma of the Bladder in Patient Younger than 20 Years Old / 대한비뇨기과학회지

Transitional cell carcinoma of the bladder in children and adolescents is extremely rare. In patients younger than 20, bladder cancer tends to express a well-differentiated histology and behave in a more indolent fashion. Younger patients appear to have a more favorable prognosis because they present more frequently with superficial and low-grade tumors, We report two cases of transitional cell carcinoma of the bladder in patient younger than 20 years old.

A Case of Urinary Tract Tuberculosis in Childhood / 대한비뇨기과학회지

The incidence of pulmonary tuberculosis decreased from 5.1% in 1965 to 1.0% in 1995 in Korea but no statistics about the incidence of urinary tuberculosis have been reported yet. The urinary tuberculosis in childhood is known to be a rare disease because of its long latent period. We report a case of urinary tuberculosis in a 9 year old girl.

A Case of Mixed Infected Cerebral Malaria

Cerebral malaria means that the patient with demonstrable asexual forms of Plasmodium falciparum in peripheral blood smear who have disturbed mental state and in whom other causes of encephalopathy, such as bacterial, fungal, or viral meningoenoephalitides, drug intoxications other metabolic disease have been excluded. In cerebral malaria, the mortality rate is up to 30% and most of death is within 96 hours, so is known as neurological emergency that urgent treatment should be required. A 42 years old male patients admitted our emergency room with spiking fever 2 days before admission and drowsy mental state at the moming of admission day. The patient traveled in Africal 2 weeks ago. On physical and neurologic examination, the hepatomegaly, drowsy mental state and divergent eyeball was observed. Brain CT scan was normal but pulmonary edema was seen in chest PA and mild increased protein(76mg/dl) was observed in spinal tapping. In peripheral blood smear, severe thrombocytopenia and trophozoa of ring form and band form wer found so diagnosed as mixed infected cerebral malaria. The patient was started the treatment of chloroguine and tetracycline and recovered 2 weeks after treatment. Cerebral malaria should be once considered as differential diagnosis in patients with unknown origin fever and mental confusion in intemalized society like modem.

A Case of the Generalized Myokymia Associated with Lung Cancer

There are widely recognized unusual remote neurological manifestations of internal malignancy. However, as far as the author's knowledge, the generalized myokymia associated with myokymic discharge has not been reported as paraneoplastic syndrome earlier. The patient was a 63-year-old female with generalized myokymia and paresthesia for 4months. The nerve conduction study revealed mild sensorimotor polyneuropathy and EMG study showed the generalized myokymic discharges, which were not changed by sleeping or brachial plexus block. The carbamazepine reduced the amount of myokymia and myokymic discharges but not the benzodiazepine. The diagnosis of lung cancer was confirmed by needle aspiration biopsy, and the cell types of lung cancer were mixed undifferentiated and small cell type. By the administration of anti-cancer drugs including cisplatin, the myokymia and myokymic discharges were completely disappeared. The patient died at 8 months after the diagnosis.